HomeMy WebLinkAbout08-12-13 �
' � 1505610101
REV-1501J "��,_,�> �1
PA Oepartment qf Reve�ue P�X�Ya� OFFICIAL USE ONLY
BureauofIndiWdualTaxes "`" ` CWntYC�e Year FAeNu�
aa eoxsao5os INHERITANCE TAX RETURN
Narrisbu ,PA 1�iz6-o6oi RESIdENT DECEpEN7.
ENTER DEGEGENT INF4RMATIQN BEIOW
Soclal Security N!!���um';;b''��er�
�,�, � �Li���LYiLY� tiYJiv1G���
DeoedenYs(.ast Name Suffix decedenYs First Natne MI
�..� ��� �
(If Applicable)Enter Survfv4ng$pouse's Informatlon Below
Spquse's Last Name Suffix Spouse's First Name MI
� ����� ❑
Spouse's Socia�security Numher 7}{�g RfTURH MUST$E FILED 1N DUPLtCASE WITH THE
t 1 1 � 1 �� REGISTER OF WI�L3
PILI IN APPROPRIATE dYAL$BELOW
� 1.Origioal Return p 2. 5uppiamentai Return O 3. Remaindder ReNm(date ai death
pripr to 12-13-02)
� 4. Limited Estate p 4a.Future intereat Compromisa(date ot � 5. Federai Estate Tsx Retum Required
death after 12•72-82)
p 6. Decedent Olad Testate p 7. Llecedent Ma(ntained a Living 7rust _ 8. Tota{Number of Safe Depos(t Boxes
{Attach Copy of Wf0) (Attach Copy of Trust)
p 9.Litigation Procceds Received � 10. Spousal Poverty Credit(date of death Ci 11. Etaction to tax urMer Sec.9113(A)
behveen 12-31-91 and 1-1-95) {Attach Soh.O)
CORRESPqNDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFpRMATION SHOULD BE DIRECTEO T0:
Name Daytlme T�ephone lUumber
� �- �7�' .�J�
NEGISTER�LLLS USE ONIY
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Firat line of address � � �w � O
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Second lins of address z {n z'+
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Cily or Post Office State ZIA Cale � � �� DA�FILEi�: -�
,._ r+�r
I �' � � ti1 f � " ,
-,�
GorrespondenYs amaii sddress:
Untler penelties of perjury,I declare ihat I have ex8mined Mis relum,incluOing eccompanying schetlulea and sis[ements,antl to the best oi my knowledg9 and belief,
ft is true, and cAmpiete.DeGaza� W preparer aLner than the pe(sonei rspresertative is based an aii IMortnarion af whiG�preparer has any knqvAedge.
5 GN E OF PER30N P NSI OR_�yFyj�LIN/CntE/TURN �Dl�TE �/ �
..YAd/sG� j z r
ADPRESS �
SIGNA7URE dF PREPARER OTHER 7HAN REPRESENTATIVE DA7E
AGORESS
PIEASE 43E ORIGINAL FORM ONLY
Side 1
� 150561D101 150561�1C31 J
J 15�56101Q5
REV-1500 EX
Decedent's Sociai Secur(ty Number
ber,edenfs Name: � . �� ��� ��
RECAPITULA710N
Y�b� �iNr r ylUp il YIII iP
�
1. Reat Eskts{Set�u�A}. ............... ........ ....... ........... 1. + JI
i
���ow i�ru ii� �
2. Stocks and Bonds(SChedule B) . ... ... .. .. .. . .. .. .. .. .. . .. ... . 2. �q ��
3. Ctasely Netd Cor{.�ataon.Partnership or Sois-ProprietorshiP(Sehed�tle C} ..... 3.
4. Mortgages and Notes Receivable(Schedule DJ .. . .. . .. ... . . ...... ... ..... 4. :- i � ��..
■
5. Cash,Bar�c Oeposits artd Miaca#arteous Personal PropeNy(Schedute E}. ...... 5. �
6. JoinUy Owned Property(3chedufe F) p Sepssrrate BiNpig Requested . ...... 8. �
T. Inteo-Yrvns Transtars&Misceilaneous IVon-Pro6ate AropeAy
(SCheduie G) O Se�tate 9Hlirtg i2equested........ 7. �
8- Tatal Grons Aaaats(Wtal Lines 1 through 7).... ......... .. ....... . . ..._ $, .. ! ,
9. F�nerei Expeases and AdmfnisVative Costs{Sdiedufe H}. .. ... ...... . .... . . 9. , � (,
10. Debts of Decedent,Mortgage Liabilitiea,and Liens{Sehedule 4j__.'......... 10. ; � �r ; ^. � � �
II
iS. 7otat Daductlons(fotaE titres 9 and 10). ..... . .. . .. ...... .. . ... ... .. .... ti. � ` ..
12. Nst Va4ue of EaRate(Line 8 minus line 11} ............ ........ .......... ?2..' ' t.
13. Ghariiable s�d Govemmentei BequestaJ3ec 91t3 Trusts for whiefi
an efection to taac has not b9en made(Schedule J) . ... . .. . .. . .. . . . .. . .. . . . 73. �
74. Nat Yatue SubJect to 7ax(Line 12 minus E'are t3} ........................ t4. � �- . i
SAX CA4Ci3LATlOti�SEE Ni�#tUCT!(k}$�OR pppt�CABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rete,or
t(apSf@(5 Utid81'Se0.91t6 �rr"�ws wr n i �wxw � i �ueq�eui nirynu � r�
(a}(1.2}X.4_. . 3 � i5. p r
16. Amount of Line 1A taxable �� I��I III�III
at lineal rate X.p._ �* , !g, z
i 7. RmouM�tina 1d taxabie
at sibfing rate X.12 �7.�
78. Amaunt of Li�e 14 taxabla
at cWlaterai rate X.15 ig,
19. 7AX DUE ..... .. . .. ... ... ... .. . .. ... ... ... . .. ... ... . . . .. . .. . ...... 19.
20. FN.t tN iFiE OVAL tF YOU ARE RE41�S71tN3 A REFtNid CIF AN OV�pPAYMENT d .
Sf�Fe 2
`,�, 1505610105 1505610105 �
REV-5506 E7j�� Pile Number
decedent's Gompiete Address:
� DECEDENTS y@d{LLY�GN�.._�'��R"�
�
zJ
STREET ESS —_—.. .—._--.—�.—.— . .. �.—�.—
----`����_E T��d��_t�i__ _----- --- - -- - ----- __ �--
------_____-----
cin srn� — �z�a--— —---
� " v' � � '���.7� �
Ta�c Payments and Credits: �
1. Tax Due{P�e 2,Line 19} {t)
2. Cr�tslPapmer+ts
A.PriorPayment� ��__.---_—,_—��
B.Discouni
_---_—— _.— TWaI Credits{A+8) {2)
3. InEetest
!3i '
4. If Line 2 is greater than Line 1 +Gi�3,enfer Ihe difierencs. This is ihe OVERPAYMENT.
FlB in ovai on P�ga 2,tine 20 ta raquest a refumf. (4}
5. If Line 1+line 3 is greater than lirie 2,errter the diHerence.This is Ure TAX DUE. (5) �
� Make check payable ta: REGISTER OF WIEES,AGENT.
PLEASE ANSIIYER TNE FalLOWING QUES'11QMS BY PIACING AN "X" !N THE APPROPRIATE BLOCKS
i. Did dec�den#maka a transfer and: Y� No
a. re�n tl�e use ar income of the property trarasterred:............_.......................
..................................................... ❑
n. re4ain me rigM w�a�who snau use u�e property vansreved«Its income�......................................_.... ❑ C�
a. retain a reversionary irtterest;�......................................_.................................................................................. ❑ �
d. receive the promfse 1'or life of either payments�benefits or care7......................................_.._............_............ ❑ �
2. !f death accurted aHer Dec.12,1982,did decedent iransfer property within orre year of death
witlwut receiving adequate Considerefion?.............................................................................................................. ❑ �
3. Did decedent own an'in trust for"a payatde-upon-death bank account or securiry at his or her deaih?.............. ❑ �
4. Did decedent own an individual re6rement account,annuity pr other non-probate property,which
contains a benefiaary desgna6qn? ........................................................................................................................ � ❑
iF TNE AN5YYER TO AN��THE ABOYE QUESTIQNS kS YES,YOU AEUSi GO�IPLETE SCHEDULE G ANQ FILE ff AS PART OF THE RETURN.
for da�of�ath at or after Jtdy 1,499d,ar�6efore Jan.1,1995,die tax�ate impased on the r�t wak�e af transEers to a fa the use of the surviving sqwse is
3 percent[72 P.5.§8116(a){t.tj 4i)].
�6F 1�8t2S Of tiC�t Oti Of 8�8( .�9tY. '�, ��d� 111e 187C l818 ItitppSEd �t 2� flCl VBIU@ 4S U2115f91B YO 4f kY[ !hB U5C Of 1172 �lNIYIflSJ SpplSB IS O p8fC811�
(72 P.3.§9118(a}{L1)(ti)j.The s�4uke does rwt eacempt a Uansfer Ro a surviving spouse trom tax,and the staWtoty requirements for disdosure of s�ssets and
f�g a tax telum are stiN applicaWe even if Ihe surviving sEause is the onty benetk;iary.
Fa�s t�d�th an or�,k�p 1,2040:
* The tan ra� imposed an the net value of transfers trom a deceased child 27 years of age w younger at death to a for the use of a naiural parent, an
adoptrve parent or a stepparent ot the chiM is 0 percent(72 P.S.§91i8(a)(1.2j].
• Tt�e ta�c r�te impased a� ihe net value af hansiers M ar fa the use of the decedents fineai ber�eflr,iaries is 4.5 percent, except as rwied in
�z Ps.gs��s��.2}nz ps.§s�tsie)iti)I•
• The ta�r rete imposed on tl7e net vaiue of transfers to a for ihe use of ihe decedenPS s+'biings is 12 percaerrt(72 P.S.§911fi(aKi.3}],A sibGng is defined,�der
Section 94d2,as an individusl who has at ieast one paren#in t�mmat ratidr ttte decedent,xdiether by 6bod a ad�bon.
i
i
nev-rsio�x+tos-o9�
�pennsyivania SCHEDULE G
o�a�eTe�«TOFUe�«� INTER-YIY4S TRANSFERS AND
«�^�T^x�� MISC. NON-PROBATE PROPERTY
� a�to�t+r oEC�rrr
ESTATE OF � Q V1 C.Z r Gl ,`,� l..,i�S�G(, t t FiLE NUMBER
This schedule mu#bc mmpkted at�8 flied it tl�e assswer to any�questians i khrougfi 4 mti p3ge three Uf Me REY4504 is}res.
� DESCRCVTION OF PRqPE0.TY 6ATE OP DEAIH %OF�A5 IXCUlSSOH TAXABLE
v+wme me w+e oF ne m�.nmx AaA�m o�aarr uu
NUMBER neaveaixNwa.�rr�a�tonaneo�w�anr�.r�re. VALUEOFASSET INNfEERESf VALUE �
1.
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1NHEFxTlr�cE TAI(AENHN ADAAINISTRATIYE COSTS
RES�DETiT DECf6ENT ' �
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e. AOMINlSTRATNE CASTS: • �'�'"� '�
1. PerEOr�Repr�tive's Curt�n�sia�s
N81M Of PBI900fi��B�IpbB11�YBi6}
$hU9i/�/885
� � �
Yt�(8)Cw�BiaS PBid: '_
2. AlOpney Fees
3, fmnNy ExtlrttpNOin:{fl decedenl'E adrke8s b nol tlle 9eme as d�meM's,BdecA 0zqenatlon)
Clukrent_�... _
She�Address �. . _�_,._�,.�
CRy Stp� Zp
R�stiareiap�C�Snt�UecedeM __ ...—
d. Probete Fees �
5. AcruunWnPs Fees ' '
6. Teu tteWm P�epazers Fees _ . .
7.
,�Att,,���,�$,�,,�} s J S�d �
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REV-iso8 Ex+(ii-io) I
'�i�J'pennsytvania ��M�DU�6 E
��v DEPARTMENTOFflEVENUE CASH, BANK DEPOSITS & MISC•
�NHeaiTANCe rn�c aEruRN pERSONAL PROPERT1f`
RESIDENT DECEDENT
ESTATE OP: RILE NUMBER:
�'j ax�c� ra C�u.�-Stn c�.t 1
incluQe the proceeds af litigation and the date the proceeds were received by tha estate.
All property jolnqy owned with right of survivonhip must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH �
ERC�� '� C�l� "'7 �.-7. �p
� °d�� `�q �Y'��-- �p�zS33.��
�
!°!ba'� �'9-v ''�S y�o . 7�s-
'l�aa�} L �- Savn�s ap�b � �o
TOTAL(Also enter on Line 5, Recapitulation} # b� J�
If more space is needed,use additionai sheets of paper af the same sfze.
R�+-isi�ex+{m-ro}
�pennsytvania SCHEDULE �
MHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: � � � �t �� �f t FILE NUMBER:
Q�('\ T' i 1
REIATION5HIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVMG PRpPER1Y Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal tlis[ributions and transfea under
Sec.911fi(a}(1.2}.j
1.
ENTER DOl1AR AMOUNTS FpR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH IB OF REVd566 COVER SHEET,AS APPROPRIATE.
u NQN-TAxABIE pSSTRiBUTI0N5
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN EIECTION TO TAX IS N07 TAKEN;
L
B. CNARITABLE AND GOVERNMENTAL DtSTRIBUTi0N5:
1.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DiSTRIBUTi4NS 4N LINE 13 OF REV-1500 COVER SHEET. $
� If mare sp8ce is needed,use additionai sheets of paper of the same size.