HomeMy WebLinkAbout05-24-13 � 1505610�01
REV-1500 °"°���°, lt�'
PA Departmerd of Revmue P�KY���y �FFICIAL USE ONLY
Bureau of Individual Taxes �aY� Y� Fae Number
PO BOX�8o6oi INNERITANCE Ti4X RETURN a I � Z O h � �
Harrisburq,PA i7vB-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW �
Social Security Number Date of Death AIMDDYYYY IJate of Birth hM1DDYYYY
I ooc� a � � � Uc� a � � `� H �
DeoedenPs Lest Name Suffix Decedenfs First Name Mt
fiJ Q � 1 �J b: V � `�' t� E ( V 'r �
(H Appliwble)Enter SunWing Spouse'c IMormatio�Below
Spouse s Last Name Suffix Spouse's First Name MI
Spouse's Social Security Numbar
THIS RETURN MUST BE FlLED IN DUPLICATE WITH 7HE
, REGISTER OF WNLLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Relum O 2.Supplernental Retum p 3. Rertiainder Relum(date of death
priar to 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of � 5. Federal Estate Tax Retum Required
death after 12-12•82)
C.1 6. Decedent�ied Testate O 7.Decedent Maintained a livirig Trust _ 6. Totai Number of Sete Deposit Boxes
(Attach Copy of Wili) (Attach Copy of Trust)
p 9.Litlgation Proceeds Received O 10.Spousal Poverry Cretlit(dat�r of dea[h Q 71. Election to faz under Sec.9113(A)
belween 1231-97 enC 1-1-�5) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAJ(INFURMAiION SNOUID BE DIRECTED T0:
Name Daytlme Telephone Number
�. � nda 1� c � � y � � � �q 3 �"�5 �' 8 `1
� REGISTER OF WIIL.S USE ONLV
�
First line of address � � ,
I c �, . '`a
�U �f Q �:c� � w c �+ c` C'_ i 2 C 1 L' � � ; _
SeconA line oT address I � } ��' ..
.. ,__ _ r.,, . .
, �.` <.�� . , -`- ._ ...
Ciry or Post Olfice State ZIP Cotle — � "�A7E�iEO -
�„ .
� t � er S P (� i � 3 � 9 . �; _.
corr� oaenc•s e,�an aaaress- o �-, "
vo - I ',ar� 5 @ y��ao.cl� � ' ;�� -7r
Under penakies of peryury,l dedare thal I have examined Mis retum.indudinB�mpanying schedules and statemenN,,and to ihe best of my k�rowletlge and belief,
it is We,correct and complate.DeGa2lion of preparer other than the personel representeMe is basea on all iMortnadon of which preparer hes any knowletlge.
SI N RE OF PERSON�FOR FILING RETURN — °—_" DATE
,AD6R�SS ___ ���__....�..�..._�.��.,.,..�_,.._._._._u__.�S ._���OI3 �
SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE ����.�����__.�_�___..__._m__.�..-DATE �
___—. .__._._ _.'—"__'_'___"" '__ '__"_'�_'—_____
ADDRE55 . �...._.._._,__�.__'_'—_ ___._._ ..,.....__ ..v.... ��_
_.._,.,..._. ._.__..,._.....,......_,u�— _... .._._.._ . ....._. .._,._.�._._.�r
PLEASE USE ORIGINAL FORM ONLY �
Side 1
� 15056101D1 L50561�101 � �
��
J 1505610105
REV-1500 EX
DecedenYs Sociai Sacuriry Number
��s�: l��r-o`1 �_<_Su.��Sb v ��_-- -- - ----
----- ----- _ .__.
_-- --- ____ -
RECAPITIJLATION
1. Real Estate(Schedule A). .............................................. L ... , .
2. Stocks and Bords(Sd�edule B) ........ .........._ .............-- .... 2. •
3. Cbsery Held Corporation.Partr�eiship or SolaProprietorship(Schedule C) ...... 3. •
4. Mortgages aiW Noffis ReceivaMe(Sdiedule D)......... .......... .... .... 4. •
5. Cash,Bank Daposils and Miscellaneous Personal Property(Sd�etlule E)... .... 5. � �J d rj C) . Cl 6
6. Jointly Owned Property(Schatlule F) O SeParate BiNing Requested ....... 6. .
7. IntervYrvos Transfers&Miscellaneous Nai-Pioba[e Property
(SChedule G) r'7 Separate Billirg Requested........ 7. .
8. Total Gross Asaets(total Lines 1 Mrough 7)............................. 8. ) 3 a 5 v . p 0
..__._.....___.....__._____�--__-__-_--_..______..__��_..��_.�_.._..___�___._.--.
9. Funeral Expenses and Adminishative Costs(Schedule H)................ ... 9. 3 � � 3 ,g �
10. Debts of Decedent.Mortgage Liabilibes,and Liens(Schedule 1) .............. 10. 9 U a � ' U �
11. Total Deduetions(tota�lines 9 and 10)....................... . ... ...... 11. ) � � 5 �•� �
12. Net Value of Estate(Li�8 minus Line'it) . .................... ......... 12. ' � U Q . C G
13. Charitable and Govemmental BequesLSlSec 9113 Tnrsts for which
an election to tau has not been mede(Schedule J) ........................ 13. .
14. Net Valus Sub)set to Tax(Line 12 minus Lioe 13) ........................ 14. I U O � • (� V
..-...r._-.__._e __..�„___.__.4�...___...__...�,.__.,_.__�_._., _
TAX CALCULATION-SEE INSTRUCTIONS POR APPLICABLE RATES
15. Amount ot Line 14 haxable
at the spousal tax rate,or
[ransfers under Sec.9116
(a)(1.2)X.0_ . 15. .
16. Amount of Line 14 taxable
at lineai rate x.o y 5 � �j.() U ts. .
17. Amount of line 14 faxable
at siblirg rate X.12 • 77. •
18. Amoun[of line 14 taxeble
at cdlateral rate X.15 • 18. •
19. TAXDUE ._...............'.._'............._..".'......_.... 19. 1 S� (� d
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Sld@ 2
� 150561D105 1505610105 J
REV-go8 EX+(ii-io)
� , pennsylvania SCNEDULE E
°E°^R�ME���F AE�E��E CASH, BANK DEPOSITS & MISC.
'""ER'T""`E'"" REr�a" PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
_�����_�� . . , sb,,f aui 3 �039 3
Indude the proc�eds of litigation and the date the proceeds were received by the estate.
All proper[y jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
/ i;, ,.k C'. CCC� -� t� f� � � U . O�
�
.� _ _ � `� IV�55G.� -1-f'p,..�iLr �'�� I.� S�OU( -.�� I.S �- �/C �'. �' <.�
TOTAL(Atso enter on Line 5, rtecapim�ation) ; / 3 � 5��, ��L
If more space is needed, use additional sheets ot paper of the same sizc�.
. utv.iSiiEx.�ivaw�
scN�ou� N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES �
INMERITANCF TA7(REfURN ADMINISTRATIVE COSTS
RESNEM OECEOENT
ESTA E OF FILE NUMBER
Le r�T� � sa�, S�O� r�
Debts of deeedent muat be reported on&hedula L
ITEM
NUMBER DESCflIPT10N AMOUNT
n. ' FUNEFAI EXPENSES:� —�S�cJ� �,W-G I �u,,,�c Gt,�.�4,.._,,., � G �p �- ��
��n�-s��.-� � p,� .._. � �
'- E'vr Cr-�c.�.,.a._�-� �.. i �c..�irc<< SsJ�vi�ce �. o i�(C„�o ���.-�Y
Gu.— �o s p. �ca 1
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Represenhafive(s)
__... . . .. _ _ _ .. . ._..
SbeetAddress . _. __
City :iU�e Lp - --. .
Year(s)Commission Paid
2. Atlomey Fees
3. Famity Exemptbn:(II decedenPs address is rrot ihe same as daimant's,atladi explanation)
Claimant
StreetAtltlress
City __ Slate Zip . .... . _..
Relationship ofClaimantto Deceden�
4. P�����5 �5 S, o 0
5. AccounlanCs Fees
6. Taz Retum Preparer's fees
7.
TOTAL(Also enter on lirre 9,���,��a�> �3 .a 3 r (��
(N more space is needed,inseR addilional sheets ot Ue same size)
RCV4512 CX4 (12-OBJ
pennsylvania SCHEDULE I
�EPRRTMENT DF NEVENUE DEBTS OF DECEDENT,
INHERITANCE TNIt RE7U0.N MORTGAGE LIABILITIES 8c LIENS
0.ESIDENT DECEDENi
ESTA E OF FILE NUNBER
� cr-oy � � ,Sa � i 5�oc� �`1 ��-U I 3'0� 3 ��
Report debts mcurred by the decedent priw to that remainad unpaid at the date of death,iMlud'n�g unreimbursed medicsl expenses.
ITEM VRLUE AT DA1E
NUMBER DESCItiPiION OF DEATH
1. �,J.S �q /"�CiS�tJ-- C� /�ow C•. �.pl.lcc.�cz.� c..,e-�-� q'� 0 � '� � U �
1...�e S�� L4 S 52�� M tr c..�.as.-n--�
TOTAL(Also enter on Line S0, Reaipitulation) ¢ q o a . o d
If more space is�meded,insert addi[ional sheels of the same size.
REV-/:�FX P.-�ge:f F�e H�unber
DecedenYs Complete Address� �� I 3 - G b 3 `1
DECEDENTS NAME
�.eCp�t � . �jc�� S �J_f� __ —
�
STREETIADDRESS , f
- - -- - -_
... It� _�.`_ �u�'C �C S�_ __..
��tt --__ --- _ _ � SrA;� P�+- Z 1 �5 �
S1�� �„sb v r
Tax Payments and Credits:
t. Tax Due(Page 2,Line 19) (1) � 5. G 6
2. CreditslPeyments
A.Prior Paymenfs _—_._- —_--
6.Discount
_.__— --- ,fahal Credi4s(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the diflerence. This is the OVERPAYMEN7:
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. N Line 1 +Line 3 is greater than Line 2,enier the difierence.This is fhe TAX DUE. (5) � J�• U�
Make check payable to: REGISTER OF WILLS,AGEINT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain tlie use or ir�come of the property transferred�.......................................................................................... ❑ �
b. retain the rigM to tlesignate who shall use ihe prq�erty 6ans(erred or iGs income�............................................ ❑ �
c. rehain a reversionary interesk a.......................................................................................................................... ❑ �
d. receive ihe promise for I'rfe of eiU�x paymenfs,benefits w care?...................................................................... ❑ �
2. If death occurred aiter Dec.12.1982,did decedent trens(er property wiMin aie year of death
without receiving adequate corisideration?......_................_._........._._................................................................... ❑ m
3. Did decedent own an'in Wst foP w payable-upon-0eath bank account w security at his w her death?............. ❑ �
4. Did decedent own an individual re6rement account,annuiry or otlier noa-probate properry,which
contains a beneficiary designadon? ........................................................................................................................ ❑ �
IP THE ANSWER TO ANY Of THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OP THE RETURN.
'k_�-,r3.�`.:t" ., ,.::2. , x't `F . ._ t-Vdi,�-=��'� = ik .k.,��`S`a. �ti�:�; "` .... . _ '� ..,,w�.`u .. .:;:_a» b�€�x::,nkr: .,
For dates of death on or after July 1, 1994,and before Jan. i, 1995,the tax rate imposed on tlie net value of trar�sfEUS to or for the use ot the survivirg spouse is
3 percent(72 P.S.§9116(a)(1.1)(i j.
For dates of � on or after J n. 1, 1995, tlie tax rate imposed on the net value of transfers to a for iMe use of the survivirg spouse is 0 percent
[72 P.S. §9116(a) (1.1) (ii)].The s ute does rrot exempt a transfer to a survNing spouse from ta�c,and the sratu6xy requiremenis for disciosure of assets am1
filing a tax reium are s611 appliq even iF tlie surviving spouse a tlie oMy benefiaary-
Fa dates of deaih on or after Juty 1,2000:
. The tax rete imposad on ihe net value of transfers fran a deceased child 21 years of;x�e w younger at death W w far the use of a natural parent, an
adopiive parent a a stepparent of the chld is 0 percent(/2 P.S.§9716(a)(12)].
. The tax rate im�OSed on the net value of Vansfers to or for Uie use of the decedenCs lir�eal barrefiaaries is 4.5 parcent, except as rroted in
72 P.S.§9116(12)(72 P.S.§9116(au1)].
• The tax rate imposed on N�e net value of transfers fo a fa tl�e use of ihe det�ent's s 12 percent(72 P.S.§9176(a)(1.3)j.A sibur�g is defined,under
Seclion 9102,as an individual who has at least one parent in common wilh tl�deceden�ether by bbod or adaption.