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Home My WebLink About09-18-13 (3) _ _ � � 1505610101 REV-1500 °`�°'_'°> �1 nns LVa111B OFFICIAL USE ONLY PA Department of Revenue P? Y County Code Year File Number Bureau of IndividualTazes �INHERITANCE TAX RETURN PO BOX Z8o6oi � � I Q rJ Harrisburg,PA i9u8-o6oi RESIDENT DECEDENT � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY � ,�,� l 2 8 0� o� 71`TI DecedenPs Last Name Suffix DecedenPs First Name MI Q S ! � N 2 �, Q (If Applleable)Enter Surviving Spouse's Informatlon Betow Spouse's Last Name Suffix Spouse's Fryirs�t Name MI .....1.._�� ❑ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Oriqinal Return p 2.Supplemental Return O 3. Remainder Retum(date of death priorto 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 72-12-82) ,� 6. Decedent Died Testate O �. Decedent Maintained a Living 7rust _ 8. Total Number of Safe Deposit Boxes (Anach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10.Spousal Poverry Credit(date of death O 11. Election to tax under Sec.9113(A) belween 12-31-91 and 1-1-95) (Attech Sch.O) CORRESPONDENT- THIS SECTION MU3T BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone N�umber � � � �,�v . . 2 � Jr 2�10�l 1�� - REGISTER OF WILLS USE ONLY First line of address 3 t �' ,� Second line of address � Clty Of POSI O�ce StefO ZIP COdB DATE FILED . Vn��r�� ' ( �::�. ..6R�..�i� .:v ��7�,.�A' CorrespondenYs e•mail address: p�it,il. W. '[narrrS �J �Wt'�i.i� . C'ovt�_ Under penatties of perjury,l 0eclare that I ha e examined ihis retum,including a panying schedules antl statements,and to ihe best of my knowledge and belief, it is true,correc[antl complete.Declaration of preparer other than the parsonal representative is basetl on all informadon of which preparer has any knowledge. SIGNATURE O ER ON RESPO IBLE FOR FILING RETURN DATE ADDRESS � r . � . ' , n I, -� ':� r, � �,. t, '' �I";0� ` , �'t � � SIGNATURE OF PR PA R OTHER THAN REPRESEN ATIVE � � DATE ADDRESS PLEASE USE ORI6INAL FORM ONLY Side 1 � 1505610101 1505610101 J _ _ __ _ 1 1505610105 �J REV-15W EX DecedenPs Sociel Seaxity Number DecedenPSName: . RECAPI'fULAT10N � r,. e, �� .uti��yr n �`�� t ; 2. Stodcs arW Bonds(Schedule B) . .. .. .. . .. ... ... ... .. .. .. ... . 2. � ;. i . �"�, I�".1�` � ,: 1. Real Estate(ScheAule A). . ... . 1 9� 3. Closely HeM CorporaUai,Pertnership or Sole-Propriatorship(Schedule C) . ... . 3. �� 4. Mortgages end Notes Receiveble(Schedule D). . ... .. . .. . .. . .. .. . .. . ... .. 4. �`, '. 5. Cash,Bank Deposits and Mlscellaneous Personal Property(Schedule E). ... .. . 5. �. �� ,� Q 6. Jointly Owned Property(Schedule F) O Separale BUling Requested ... .. . . 6 ;�� ...'� § Y �. ,.� 7. InterVivos Transfers&Misce��aneous Non•Probate Property •. �� (Sthadule G) O Separete&Iling Requested... . .. . . 7 � � �� I 8. Total Gross Asssts(total Unes 1 through 7). .. . .. . .. . .. . . . . . . . . . . . . .. ... 8. X � k � 9. Fuoeral Expenses and Adminishative Costs(Schedule H).. .. . .. . ... ... .. . 9. ' 1 '� , �� 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . ... . 10. ±�� 11. Total Daduedons(total Lines 9 and 10)... .. . .. . .. . . . . . . .. . . . . . . .. . . . . .. 1L �^. : . 12. Net Value of Estata(Line 8 mious Line 11) . . .. . .. . . . . . . . . . . . . . . . . . . . . .. . 12. "� � - '% � • � � 13. Chantable and Governmental BequestslSec 9113 Trusts for which an electioa to tax has not been made(Schedule J) . .. . .. . . . . . . . . . .. . . . . . . . 13. ' •�� . � 0 p 14. Ne!Value Subjeet to Tax(Line 12 minus Line 13) . . . . . . . . . .. . . . .. . . . . . . . . 14. �t� �- � �t� TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �•�r'�= �a)�12)X.0- w � ��m��..��.�� 15. .��a�� ... 16. at lineal reteinX 1�4 �ble Y�fti��u�11�LY1 I �I 16. ��, �� ■ II "t" � 17. Amount of Line 14 taxable � at sibling rate X J2 `' � »� 18. Amount of Line 14 taxable al collateral rate X.15 ' �8� 19. TAX DUE .. . .. .. . . . ... . . . .. . .. .. . .. . .. . . . . .. ... . . . .. . .. . . . .. . .. . .. 19. � p �. {. . 20. FILL IN THE OVAL If YOU ARE REQUESTING A REFUND OF AN OVERPAYNENT O Sid@ 2 L 1505610105 1505610105 J REV-i5o8 E%+(n-io) ' `�i�pennsylvania / SCNEDULE E �� DEPAPTMENT OF PEVENUE �./{SH� BANK DEPOSITS & MISC. �""ER„""cE T"""�r"R" pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: ` FILE NUMBER: �/�Niu l7. �.Y'n5 Inc ude the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly owned with Hght of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cdtzcicri�� ce� SovvrP��,,, ,�j�,,,,�c , 2g9/m3ss&� Sl� yo(�.37 TOTAL(Also en[er on Line 5, Recapitulation) ; �r� � If more space is needed,use additlonal sheets of paper of the same size. REV-1511 EX+(10-06) � � scNEOU�E N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TA7(RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent muat be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT a. FUNERALEXPENSES: ,. �i� �`e.,rr.. -Qoi'� � 796, �o � - �24.�k Criti�rGtc�PS ��(fh'Gr� ��I! �� , B. ADMINISTRATIVE COSTS � 1. Personal Representative's Commissions Name of Personal Re resentative 5 7 � � � a l ) 1'kl�x ax'��_lCs�`��IP— "'�1 _--- _ _�� G�� U �� 2,� 5 po ,o0 Street Address 4 _ '_ _ ___._.---- -- ___ . Clty ��.Sf��OUV;�� .� State�B�Zip �`�QQ� -._ . Year(s)Commission Paid _�9_(_7�_ . __. .... _ . _____- -.___—_____. 2. Attorney Fees � . 3. Family Exemption:Qf decedenPs address is not ihe same as claimanCs,attach explanation) � Claimant Street Address City State Zip ._, _ _ ___ _ � Relationship of Claimant to Decedent 4. Probate Fees 5. AccountanPs Fees 6. Tax Return Preparer's Fees � 7. TOTAL(Also enter on line 9, Recapitulation) $ '� ,Z �,� � Qf more space is needed,insert additional sheets of the same size) � _ REV-15,12 EX+ (12-OB) �pennsylvania SCHEDULE I DEPAFTMENTOFHEVENUE DEBTS OF DECEDENT, SNHERRANCETAXRENRN h10RTGAGE LIABILITIES & LIENS 0.ESIDENT DECEDENT . ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date oi death,including unroimbursed medical expenses. ITEM VALUE AT DATE NUMBER j DESCRIPTION OFDEATH 1. C �AJ,ylp,( �iYj�✓v�'Q ...�'�,�` .�`.(,✓� � 'tt,(SE ��' �/. 7S � . �� ,a.�A -. �i av�,a I'u�� /0 9.7 0 � �. J-fz,i�ZEii �yC - �tye ¢�a,u. 35�00 =l, ' u,�,�,�. !�r ia�!,=.ri � Y61 S - �v�,�U��c. J� . 1 s d: �1J�^.A r.!:Y•:,� �tN� � tPlC l;i��..Q_ i �, 3G,. �'s� � ,`��.�, r�_. ��F� — �}pvhwr� �a-� �;,,,,�� —�vu�,p� n��,,�- �( . �1 s � � f I� %�. _�r,� � ��;��t, — gc�� h,,�„�- r �ss7� eo � TOTAL(Also enter on Line 10, Recapitulation) ; � S �` If more space is needed, insert additional sheets of the same size. , REV-1313 EX+ (01-10) � pennsylvania SCHEDULE 7 INHERRANCE TNX RETURN BENEFICIARIES RESIDENT DECEDENT . ESTATE OF: FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRE55 OF PERSON(S)RECEIVING PROPERN Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(11).] I/ 1. ��l�� lN, �}miYn� � �3 . � � o�P-Y-�' /�{- �ZaYt^cs � �3 . � � �'�l��r��E�v�� . R�aGle Da�,�,�k�,�,• �3 � ENTER DOLLAR AMOUNTS FOR D[STRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTR[BUTIONS � A. SPOUSAL D[STRIBUTIONS UNDER SECTION 9113 FOR WHICH AN E�ECTION TO TAX IS NOT TAKEN: 1. B. CHAR[TABLE AND GOVERNMENTAL DISTRIBUTIONS: i. G�,�.�e � �fl�w�A , Can-!� s�te , pF1 r oa�, o0 , TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUT[ONS ON LINE 13 OF REV-1500 COVER SHEET. # J p,{J�� (�0 If more space is needed, use additional sheets of paper of the same size. REV-1500 EX Pege 3 Flle Number DecedenYs Complete Address: DECEDENTSNAME � . ��-�`��`r5 ----- STREETADDRESS �- ��j41��n�'-C �✓�! Y��— � �-•� �� CITY STATE ZIP C I" /� 0 Tax Payments and Credits: 1. Tax Due(Page 2,Li�19) ��) 2 h S�,y3 2. CreditslPayments � A.Pria Peyments B.Discount Total Credfts(A+B) (2) � 3. Interest (3) 9 4. If Line 2 is greater than Line 1 +Line 3,enter tl�e difierence. This is the OVERPAYMENT. FIII in aval on Page 2,Llne 20 to request a refund. (4) 5. B Line 1 t Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2 Q S D. y,3 _�_ 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 No a. retain the use or income of the Properly transferred:.......................................................................................... ❑ � b. retain the nght to designate who shall use the property transferted or its income:............................................ ❑ � c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ `� 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of dealh without receiving adequate consideretion?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-0eath bank account or security al his or her death?.............. ❑ � 4. Did decedent own an individual relirement account,annuity or other non-probate property,which contains a benefiaary designation? ........................................................................................................................ ❑ � 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 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)(ill. For dates of death on or after Jan. 1, 1995, the tax rete imposed on the net value of trensfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1)(ii)J. The statute dces not exempt a transfer to a survivirg spouse from tax, and the statutory requirements for disdosure of assets and filing a tax retum are stlll applicable even if the surviving spouse is the only benefidary. for dates of death on or after July 1,2000: . The tax rate imposed on the rret 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)(12)]. • 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(12)[72 P.S.§9116(a)(1)1. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.