HomeMy WebLinkAbout09-24-13 (2) 15056101�1
� REY-1500 �<°t�'o, �"
PA DepaRmeM of Revenue P��Y��� OFFICU4I.U8E otu.Y
Burcau of Ind9vidual Taxes Couo1Y Code Year Rie Number
Poaoxzso5os INHERITANCETAXRfTURN
,PA,i iz8-aeoi Rf3lClENT DECEDENT
E R OECEDENT IliFORM1171QM BELaA/
5 'al Socurily Num6er Date of Death MMDDYVYY Date of Birth MMDDYYYY
���.�1 'R��oit 131 0 "3 4 � 9�
nPs Last Name SuNix DecedenPs First Name MI
urr � 1r^t► �� PRrzD�� ❑2
{N )Enhr SurvNeing Spatae's 1rNortnaUon Balow
S use's Last Name Sutfix Spouse's First Name Mt
i ����� �.� ����i...Li�/ ❑
S use's Scciai Security Num6er
THIS RETURN MUST BE Ff4ED IN DUPLICATE WITH THE
REGlSTER OF WI�.LS
FI l iN APPROPRtATE OVALS BELOW
1.Original ReNrn 6'� 2.Supplemental ReWm O 3. Remainder Retum(date of death
priorto 12-13-82)
4.i.{mited Estate Q 4a.Future intereat Compromise{�ate of p 6. Federai Eetats Tau ReWm Required
death ai�12-12-82)
8. DeCedent Dled Testete Q 7.qeCedent Maintained a Living Trust ,� 8. Tofsl Number of Saf�peposit Boxes
(Attach Copy M Will) (Atkach Copy W Trust)
9.Utigatian Proceeds Received Q iQ.SpaUSak Pov�1y Gedit(dete Of dasth O 11. Electian to ta�c undsr Sec.9113(A}
between 12-31-St and 4-t-95} {Attech Sch.O} .
C RESPdNOENT- THI$SECTION MUST BE COMPLETED.AI,L CORRESPpNDENCE AND CONFIDENTIAL TAX INFONMATION SHOUID BE DIRECTED T0:
N me Daydme Telephon umber
E. nt fi� A� v J R �� •'7 '°,L�
:.,..
�RRq'.IS�TER OF_ ILL�,k�SF.�NLY
.7J q f" R? �"�3
1'� � E 1 _� , 7 ;7
F rst line of atldresa 1�' N �Y� ' ,.�
=n �
3 b ��' � x::� =3 -,a
� -� .
S nd itne of address � G �� +.� '.'
;':T �_.. �' te"i
!� � .
� L 4Y7 - 1
ity w Post 4fice State ZIP Cale oA�ILED
N � � C, � a �
ortetpontlert's e•mail address: (.Q p/1Q_J'd. {'� t t-,g,r (o? d„i a .,rt r !
U der penaldes of perJury,I declere tliat I have e�mined ihis retum,indutling accompenying achedule6 and sfatemente,and ro ihe best of my knowledge and belief,
it is trt,e,Cprecl aM Complate.DeCle�atlon of(xBpArer other then tha personal representetWa is beseQ on all infam8tiqn of which pr9pa�er has any knowledge.
S GPiANRE OF PER F2ES SIBIE FOR giLtNG RETURN OATE e�
.�1. �M'f3/�
DRE$S
�� N t R-1 �7d�
GNATURE OF PREPAfiER O7HER THAN REPRESEN7d7IVE DATE
DDRESS
P�►s�use a�na3ru��ora�orur
Side 1
� 1505610101 1505610101
I
� 15�561U105 ,
RE{F-1S00 EX
. �eoa�l�nt'.s Sadk:Swrily Nwn6er
�g"� „n,�ntt�� R R�rrr�'iz
REC�ruu�
1. Real Esfale(Sti�ed�tleA}. ........:. ................. ........ ......... t. �I �I, m � nione�
2. S[OC�(8 Mld�11� .gC�116�8 B ue
� ) ....... ..... ... ... ... ........ ... ... .. . . 2.
3. CbselY.F�d Crnp�on�py�p a Sale-R'aPriebeaMV(Sc�C) ... .. 3.
4. �and Noies Raoaivahle(Sd�edub D).... ... ... ..... ... ... ... ... 4.
5. Cash.Bank Depodts and Mboe�OUS Perscnal ProRxh(SchedWe E)... .. . . 5. y , �. , .
s. ,ro�nr a,�a a�ry tsaea,�e F> o saw�•e�ne Re�a .... ... s. l � 2 7; -3:
7. Inter-Yrvos TransPers&MFSCel�neous Non-Pm6ate�prpperty'
(Schedule G) O Se{�rate�Iling Requested.... .. . . 7.
8. ToW Gross.AWb(to�l Lirres 1 throu9h 7). .. .. . ..... . .. . .. . .. .. . ... .. . 8. � . ..2 n. ..'..
'i
9. Fwceral Expenses and Adminiatra6ve Costs(Sdre�fule H)... ... ... ... ..... . . 9. .'Z '� �( _ O
�o. oeete os oeeede�,c.naoneage�iawmies,a�d�iens�soneawe p ... .. .. .. . . . �o. Z �( y
11. Total QMUCEfons(�tal Lines 9 and 10).. . .. . .. . .. ... ... . . . . . ... ..... . .. 11. . �� �.. ... ..l `a-
t2. ti�t vdusot EslaES(�ine 8 mimu tine tt) . . .. ... . . . . . .. . . . . .. . .. . . .. t2. �. �-I O p 1.
13. Charifable and Govemmental BequeaWSec 91t3 Trusts for which
an election to taz has riot 6een made(Schedule J) .. . .. . .... . .. ... .. . ... .. 13.
14. N�t YNue�6ject to Tax(Line 12 minus Line 13) . .. . .. ... . .. .. . .. . .. . .. . 14. � . .� �{ � p :
TAX CALCU44'flON-SEE�. � . FOR APPLICABLE RAtES �
15. Amount ot Line 14 taxabte
at the spousal tax rate,or
Vansters untler Sea 9116 • r .� �
(a)(1.2)X.0_ ! � t5. �.
16. Amount of Line 14 taxaWe � r II �I �
at lineal rete x.o� t8. (p . �. Q:.� . . �..$ .(j
17. Amount W Line 14 taxable
� at sibling refe. X.42 �7.
18. Amount of Line 14 taxable
at cofVateral rete X.15 �g, �
19. TAX DUE .... . .. .. .. . .. .. ... .. ... ... ...... .. ..... ... ... .... .. .. 19. � �p '1 �
20. F�LL W 7NL OVAL IF YOU ARE REGUESTWfs A REFUND OF AN 01fE/1FlWMEN� �
�dt2
� 15Q561D1U5 15Q561U1Q5 �
,
REV•1500 EX Psg�3 Flle Numtlsr
1I6{7o�,!{� `iQm��ri��$:
��
M,� R .- R�-�-� _ �—. -
__ s�,��.. ,��.�_�r_Z__ -
- - - -
��ny STATE [� 21F
t M'j"M1 t� t � ! �l)1
T�uc Pa a�d Cro�d�:
�. �o� z,�.�ta) t�� b`�R 3. 86
s.
A Pria
i e.o� �.a4,b� t ) t�} �7.L1./a9
T�{�s a+6
3. NOarest
(3)
4. !f Line 2� tl�an tine 1+i.ete 3,e�'tltie�. it�s is tlre OYEI�AYIIEltT.
FH k4 o�si on P'ags$lina 2@ M�aqtret s iakmd. {4)
5. H Line 1+L ne 3's grea�r tlwn Lhe 2,erd�'Hre dfiarence.fis is Uie 7AX Dk�. ES) (� � (o�'. / ?
Make ct�ck payal�ta: REGISTER OF WlLIS,AGENT.
E ANSYMER THE FOLL0IMNG QttESTIONS BY PtACMKs`AN"X" IN TF�APFROP'RU1TE BLbCKS
1. Oed decedent�k�s a�r md: Yas Nr-o,/
a. romin ttre use ar inwme c�the property trar�sfercecl�.......................................................................................... ❑ L,.,;�1/
b, retain dre rlgM to desgna�wl»shaq use the property transterred a ils inrume�............................................ ❑ l.�
e. tefain a reversionaty i�terest;a_.._.................................................................................................................... ❑ �/
a. re�eive ihe p�romise ta�ife a eii�er payrnents�6errer�fs a csre?...................................................................... D CI
2. if d�th oourtred aRer Dec.12,1982,�d decedent bansfer ProVertY within c�ne year nf d�th
wilhqtE rc�xiving sde4uate mnsideration?.................._.....,._......_......._........,.,......._............................................ ❑ Qr
3. did tlecedent own an m hust�w payaNe-upon-cl�th 6ank account w security at tris ar her deaUi?.............. � �
4. pid dec�dent own an individuaf reBrerrrent account,ennuity or other non•p�trate property,which
amtains a berreflaary designation? ........................................................................................................................ Q� ❑
IF i}iE TQ M!Y OF TFF�ABt1YE GUESTIGNS IS YES�YOtf�tS7 COMPLETE SCHEDULE 6l11�fiLE IT RS PlIRT OF THE RETURN.
Fa t�e.s� an a BRe�JuPj t�t99d,�!De�re Jan.1,1995,tlte t�tate iropased c�r Me r�t vak�of tsanstets ta�sr for�re ctss ofi U�e sur+mitg�ot�se is
3 percent(!2 S.§9118(a}(i.t}(i}j.
Far dates of on a ai�r Jen. 1, 1995. tlie ta�c rate imposa! on the net vaiue of transiers to or tar tlie use d the surviving s�aue is 0 pereeni
(T2 P.S.§911fi(a}(4.1}{�}y The sFa�doex�X ex�a Eransfer 6o a swvivmg spouse ftom haac,�ruf the shaRutay re�rert�ents#a�isci�re af assets snd
fNing s� �e siNl aDP�+��ever+'rf ttfe survi�rg spase is tlie a�ly benefiaary.
Fa dales ot on a�r July 1,2000:
• The ta�c "rr�pOSed at itae+�et u�of Ganst�s iran a deceased r�!21 yea�s of�e ar yourger at�r�ar far tl�e uss td a nahxaat�er�t, �t
adop8ve a a staD#�arent�Uie ct�C9 is 0 percent{72 F.S.§911fi(axt 2}].
• The taac te imposed on Ure r�et value of transfers to w for the use of fhe decedenPs Nneai hene8ciaries is 4.5 percent, except as noted in
n Fs.§s �e��za[r2QS.§s»s(a)(�)].
• The t��a imposed on tt�tret t�e ot transfers ta or far the use of ttre�nYs sibGng,s�t2 pert��t�2 P.S.§91t6(a}(4.3}].A�ng is det`inad,�er
Section 94 2,as an individual who has at least one parent in cammon with tlre decedent,whether hy Waod w adopUon.
I
�
REV-35S18�Yy+(SS-16}
, � pennsylvania � �iCMBbUL! �
DEPANTMENT OF HEVENUE y/i.iHl BANK DEPOSITS& MISC�
ir�xEatrarace iax RETUaN pERSONAI. PRBPERTY
0.ESIDENT OECEDENT
ESTATE OF: Fx1.E NUMBER:
PYlsY s �' G?� '� tT 01w
Include the proceeds of IitigaNan and the date the prpceeds were received by the estate.
. All propeHy jolntly owned wilfi right of survivorship must be diaclosed on Schedule P,
TfEM VALUE AT pATE �
NUMB£ DESCRIPTiON 6F DEATH
� CYFS`{ lN 1"5�4�J1�- "17l �IL7, 50
(
�
�
�
TOTAL(Afso enter on Line 5, Recapitulatio�) ; 1{� 01$,s
If more sp2ce is needed,use additional sheets of paper of the same size.
,
RE4-151 E%+(OBA9)
y� SCHEDULE G
oE��evEm� INTER-VIYQS 7'RAiriSFERS AND
�""�E""""�T^x"�'" MISC. NON-PR4BATE PROPERTY '
RESIDENi DECWLA/f �.
.���{� �� �y�
�- � ( ' Q� � Q�O�
This scheduk must be canpkted and flled if the answer to a�ry af pues[ions 1 through 4 on paqe thra d the REV-1500 is ya.
REM DESCRiPiTtkt OF PROPERFY MTE OF OFAiN %OF OE�S EXCWSION TAXABIE
ucuoe ne wve an�t mwae�,tr��n�remcr�ertuo
NUMfi�t n�amarn�n.�rna�avrrrnEO�wnaexanrtE. VRLUEOF1155ET 1Ni6tEST VALUE
i.
�s�_I_rJ__..1i,t�aKCIG�_VnR,i4�.__.�+���'r'�.t --..._. I"��7�7,2t 1� !�{�'I37.11
�
- t,�ONnRtS_,R_�vrt�2R.__at2-{_ 50�.._"i-30`�7_.._
� _-1±�l.L�STn�Z.. -��?�!+An.r!�..�_vS--6^'^'u�`r-./_ -- 'iS�yi7.s�( la� �8� 417,s"f
r
_!-�t�e1��...l4�_��'CtE'�-'"(?r�£°n'�r--�r-�-t3-----
3 t.,ucottv +,{o( tc tt,?6b.Y7 --��—°- lt� 766.v7
L.E'�R�r +�. {��tt'rk� .d21 5u�ut 7- 7�0-�3
'�1 �,NCa.� FiNrwci� P��J A,v+w�'rY 33�'Sy7, t�__ 3, 3y7,5"2
��c�uA/�3 �4- .(�� J6ti SUn.t 't-au-�3
� «a8hlcr.+ F�A+�C.fL r�JTvrtt- �'v+�t(� cicp�f.G! �___ !���L.._
4.Eca�Ar2.b A, Q�rrrG2 J2 � �^'� "�-ao-r3 _.._
I
TOTlYt(Aisn anter on L'+rre�,RecaP�tui�on) # /C1.Z `�'T�. 3� �
u more space�s needed,use addrklona��eets d pan�d me same size.
, _ _
_ _ _ __ _
REV-1511 E +(10-09)
pennsylvama SCHEDULE H
DEPARTMENTOFflEVENUE FUNERAL EXPENSES AND .
INHERRANCETA%RETURN ADMINISTRATIVE COSTS
0.ESIDENT UECEDENT
ESTATE F . FILE NUMBER
� -ZOI -O$8a
Decedent's debts muet be reported on Schedule I.
1TEM
NUMBE DESCRIPTION AMOUNT
n. FUNERAL EXPENSES:
�. ��r�+,*-n�r-� ay�s.�e
e, ADMIN[STRATIVE COSTS:
i. Personal RepresenWtive Commissbnr. �
Name(s)of versonal kepresentative(s) �
Street Address
City State_Z1P
Year(s)Commission Paid: � .
2. Attomey Fees: .
. 3. Famiry Exemptlon: pf decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address �
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: �0� • ��
5. Accountant Fees:
. 6. Tax Return Preparer Pees: -
�. ZF�wtPt�RAA'/ CN�CK$ Fo2 F��'TE €j•CX�
TOTAL(Also enter on Line 9, Recapitulation) ¢ �'i�-{ ( ,�'p
If more space is needed, use additional sheetr of paper of the same size.
I���I
I
R�+r-15ii epi+(i2-aa7
• pennsytvarria SCHEDULE I
�EPAPTMENT OF flEVENUE DEBTS OF DECEDENT,
'""ER'T""c�T"'t nET"an MORTGA6E LIABILITIES & LIENS
- 0.ESIDENT DECEDEM �
ESTATE F FIlE XUMOER
W+,4 � '�-f — �ot — t� S
Re rt dedts incurreA by the deawdent pHOr to death ehat romelned unpaid at the dMe oP dereh,includinq unralmbu�d medkal axpensea.
iTEM � VAU7E AT DkTE �
NUMBE DESCRIPTION pOF DEATH
' 1. (�Fn�ivL�4NG,� �� ! g.G70
a, AOGTOk�� [NVO�� KS•��
3,
ST+4tt�. �i 96.00
�
I
�
I
�
�
�
�
I ` .
�
I
TOTAL{Alsp enter on Line i0, Recapitulation) ; c.�a� �{�
If more space is needed,insert additional sheets af the same size.