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HomeMy WebLinkAbout11-14-13 (2) 1505611101 REV-1500 EX(02-11) lvania DEPARTMENT enns OFFICIAL USE ONLY PA Department of Revenue pY County Cade Year File Number Bureau of Individual Taxes F NVE FEVE PO BOX 28o6o1 INHERITANCE TAX RETURN + O 2 'r ' Harrisburg,PA 17128-0601 RESIDENT DECEDENT l J `� ENTER DECEDENT9NF.ORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01 3 08 �2 31cl AI Decedent's Last Name Suffix Decedent's First Name MI L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI y Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Return p 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate p 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED 0: Name Daytime Telephone 1_ ber= rn � .,✓ 0 Y41C R. 3 �� . 8 36 ! T OF Ip(llaLS UA MY rn vv, 70 a First Line of Address © R Q —a 6yo3 SPR1 FaRES � D rt .- r Second 'Line of Address t-� CCn p "r7 City or Post Office State ZIP Code DATE FILED 1F � t � ERic M _a1 701 Correspondent's e-mail address: /f/I0" 0'..,1,cc v,\ Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declar n of Wparer other than the personal representative is based on all information of which preparer has any knowledge. SI E OF PARSON P S LE R FILING RETURN DATE r�✓� / /b a 01 ADDRESS �yo3 S �tr1� (ores�- 12� �de��elc w l) tool SIGNATURE OF PREPARER OTHER THAWREPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 1505611101 J lTr\ 1505611201 REVA 500 EX Decedent's social Security Number Decedent's Nam: 0 RECAPITULATION 1. Real Estate(Schedule A). ................ .... .......-..... t7 q 2. Stocks and Bonds(Schedule B) ..- .......... .......--......... 2. 3, Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) 3. 4. Mortgages and Notes Receivable(Schedule 0) ... .... ............. 4. & Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... S. 6, Jointly Owned Property(Schedule F) M Separate Billing Requested 6. 7. Inter-Vivos Transfers&Miscellaneous I Non-Probate.Property 1-F (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines I through 7).......... ................ ... 8. 9, Funeral Expenses and Administrative Costs(Schedule H).......... 9.. 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). ....... ...... 10. 11. Total Deductions(total Lines 9 and 10)..... 12. Net Value of Estate(Line 8 minus Line 11) ....... .... ........ ....1..".. 12. I'BequesWSec 9113 Trusts for which 13. Charitable and Governments --111. 13 an election to tax has not been made(Schedule J) ...... p r7 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 at the spousal tax rate,or transfers under Sec.9116 16.1 Amount of Line 14 taxable at lineal rate-X.0 45- 01 16. iA 17. Amount of Line 14 taxable 17. at sibling rate X.12 18. Amount of Line 14 taxable at collateral rate X.15 •1 till. 19, TAX DUE ..... ..........-.... ......... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C= Side 2 1505611201 1505611201 REV-1500 EX Paf e 3 File Number Decedent's Complete Address: DECEDENT'S NAME - -- �JL,,, �. o STREET ADDRESS _ f /l - ---- - --- -- - CITY STATE ZIP Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments A.Prior Payments __ B.Discount Total Credits(A+B) (2) Q 3. Interest (3) rl> ..".' 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 9. 179 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 property transferred .......................................................................................... ❑ 0, b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ [r c. retain a reversionary interest ............................................................................................................................. ❑ 2 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 death without receiving adequate consideration?.............................................................................................................. ❑ L�!1 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ L�/J ❑ 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)(ii)].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(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)].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. REV-1502 EkF(01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: �qay /_ ay«� ?0/3 - All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION SI�',P�ensbu�-� i f A V"A-P ra. 3q-lq-6i71_ 00 /o0.b Ff sS�SSc� V4L4A6 .115-11 71)0 I.Zss 1/i4i ttF- c P: Pc 12at1 c -Poe $ 5'� I �7 R s9 Jc Val ell P'ARCe) ib © 0©q. I S,—0000c;0 Q5- % /rU7-EROs7- AS �ugrJT W OOMMOAt - r'ARGe-1 10r - 6 Do 47, ­0 -DOOex��)o GCUV�MUtI Je-vet ra4i0 fxnx, 'oho• 7-o7 Xl �$ 115-1 5 )a1.2 6 esS e ALL) -$,/6 3746 816 /S )0�0/0o; y 60!}s 1,1j h i°ri 1eo� br )cq era nol u nG1 �h�' -���►-� ��.¢s ,fin ;n ay��cuJ��� P���1a� cS�rtCG Z° �Cl CN✓1�-cs_ryj �;Dn ��t'li��ccS'J, 1+ Jai UC Pcre 41cvA, '-(`�� GfoPS c&re �r�.Ps � Cpf�R l w In e�-�� ��^ley l Sad bc�'►s a n cat JC..'rn-55 k\�'Vy a v\G1 PaS*Ck g'�-C) R'sen+ 6n5 are -V eon- wve 4o use fv (aAd4- -this cove-rO a 14L t 1 99 TOTAL(Also enter on Line 1, Recapitulation.) # If more space is needed,use additional sheets of paper of the same size. REV-1197(5-13) Pennsylvania SCHEDULE AU DEPARTMENT OF REVENUE AGRICULTURAL USE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION EXEMPTIONS PO BOX 28o6oi HARRISBURG PA 17128-o6oi ESTATE OF: A/-P// FILE NUMBER: ,?©/3-6031-16 Use this schedule to report real estate for which you claim an exemption from inheritance tax under the"Farmland - Other" Exemption (72 P.S. § 9111(s.1)) or the "Business of Agriculture" Exemption (72 P.S. § 9111(s)). Check the box below next to the exemption you are claiming (select only one): ❑ Business of Agriculture Exemption 2 Farmland - Other Exemption Complete Parts 1 and 2 of this form. Agricultural Conservation Easement; Agricultural Reserve; Agricultural Commodity; Agricultural Use Property; or Forest Reserve (Definitions on back of form). Complete Part 1 and check the applicable category on the back of this form. Attach a written statement explaining in detail how the real estate qualifies for the claimed exemption. In addition, if you are claiming an exemption for any structure affixed to the real estate, identify the structure and explain in detail how each structure qualifies for the claimed exemption. Structures affixed to the real estate that do not qualify for an exemption must be valued and reported on Schedule A to the Inheritance Tax Return. Please also attach all supporting documents with the written statement, including the county assessment card. Failure to provide this information may result in a denial of the claimed exemption or a delay in processing your return. PART 1: PROPERTY INFORMATION V Property Parcel Identification Number: 16 ^ Q ,j 6!7 01 }2,.—000000 Percentage of Parcel Exempted: &25- 7o O4 VQIue. ©k 1anal Date of Death value under 72 P.S. § 9121: 0 x/60, 768 Physical Location: 6e-"" y �6i4 C.f/Air�6t'��b[AS� . �i�,r9�t/�C1/�✓ STREET ADDRESS(DO NOT REPORT P.O.BOX) CITY COUNTY PART 2: OWNER(S)'S INFORMATION Provide the name and mailing address of all transferees of the real estate listed above (attach additional sheets if necessary): A26loyl vler son peen a 6q)er 15bn OWNER NAME RELATIONSHIP TO DECEDENT OWNER NAME RELATIONSHIP TO DECEDENT 6q03 66rtesi MAILING ADDRESS MAILING ADDRESS -rrec(e r i k- W-D a)"7 01 _ V i In- CITY STATE ZIP CITY STATE ZIP OWNER NAME RELATIONSHIP TO DECEDENT OWNER NAME RELATIONSHIP TO DECEDENT MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CITY STATE ZIP REV-1503 EX+(6-98) 'Wr° $ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 3N(0 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. _ o?/. 966 7 Shacre 6 of )C,Pr9WXL>A/ ,411VAA10-41- 5-62tJ1CC S CmP Cam, VALa,! AS a.z:- y y41 7, llq 5 y y TOTAL(Also enter on line 2,Recapitulation) $ / l /S �� (If more space is needed,insert additional sheets of the same size) REV-1508 EX+(ii-io) �, -.-, SCHEDULE E QPennsylvania u DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: R IV-po aye g&►3 -00 3q('0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. IM 4 i 6,44k Ch ec k,o6 AcL7 -# 1 qy a03 58 1 f4 �3�- -THar l ,+AF.S OF RALPH 4 omew .4No v/A) o y ,e �, 6 3, e� �IS 7AE /A)d}MGS 0)~ o1'LPH �- oyLFR j D /,er A"Ia Oea n ®. 0& n Irancl TOTAL(Also enter on Line 5, Recapitulation) $ yt-b If more space is needed,use additional sheets of paper of the same size. REV-1510 EX, (08-09) j pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER k& oyz&P aor 3 -00 3q6 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. �/� i�G✓1V � . Oyler, Sorb Annwy 2o,o22 loo ab, oz D �dA�s c cd /N&W 6,­�013 d c }o� '26) 0► 91 3 rfiherPS� A AL,.3 rence 4'T10/ W/ C& /�A/�N/�y! �7� l°p AJi 4-ra1)5.;Fr-rr col nun e- Ay i ,4i►nc� �y� fran5�rr r� T We i (3(a, r, :Aep--9•rpfld a Id A✓� ZS a rj7 /00 `I,97 f�n/►u��y fi�r�nA"'reCl Tare , 1 i, od c/n�Id/ :tw /np q si�/e/,otc rr ��rcns��rrPC✓9ctJ-" , /,��o .J7 r As���t'� 1t, rt r� I ��z �13 7 o /• EVi✓1 baler zv) pjjTlvr��C W �err1 �AC1Ur�� T /00 7r 7l '7 Oyler, 501), e na 1'1nINS{e;n 604014y -3 1 4/, 7/'? /06 ql 7) l 7�err'sa �cvuret')Ce� she cwj) AjQ'nu 4- 3)��� i3 a,3foo lot a,360 c� /0, flW&'f2E7- .Sfvuger/ s lepehl)d/ LJ(4_ 3�a f b0 3b7 d Ann,•4y 3�9$ -?/ i3 1l, r✓),Cheye sf-dafk Jfep-,9rn,,dcWd, /\J*T,D&I 360 We 4er,n Anywu+y llu ;2,366 c0,'d17&y ,6blr, g,�lck�l�, IJATIvA/}4_ �J fS PG✓� /4"f\M f y 312—.9)13 13 �✓rh �y�c"r �or� , /✓Rno � e���r,� /9nnu,�4, Ai 11'y a erred 3102 3 lean ©yl�c�� So/�, /✓,�rievAi. tde5le" Annwdy / o� 6 //y o y +sans�crr�d 3)a10 TOTAL(Also enter on Line 7, Recapitulation) $ 0 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER 0y I2 o`Z013-00 3g(v Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: •�'lor�c�nd �rv�e+C,�`r .� ���� �Q���G 4��p����� �,' S oc 8�'1CI�rr` Tu�1G'Kti I�O�ME' 1)l':ZN eXPE'n� l v� �f • 1 oa� .J�u'`'�e!'c�;r� ��1�-�� -- �Sune:�) 5�rv►c� �,r�C��he� a�f' B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: �j Name(s)of Personal Representative(s) (/��l I V�1 �. - ` L Street Address_ C��O 3 SDf i nq �v l % - City _____ f ^►C )C�Jrn State YVID zIP._2 170 Year(s)Commission Paid:_�\per 2. Attorney Fees: �j�0 5'e. I I e.r 6 rC`ko W-N 3. Family Exemption: (If 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: a�v 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. dry lo,nal GXPense.5 TOTAL(Also enter on Line 9, Recapitulation)Is .2 H l If more space is needed, use additional sheets of paper of the same size. ' REV-1513 EX+ (01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PN Oyu w)3- oc)3416 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec,9116(a)(1.2).] SOYI 56%1. G'v't Yl Oyler 6,03 J),-10c f are fired&t-#e k, M D a. Oean C. a)�d �b�a 760 9c(en 4x 6r. Son gyp+ * 301 Vt In)a Ouch I VA ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. y J INVENTORY REGISTER OF WILLS OF LU,IAWIA�D COUNTY,PENNSYLVANIA } COUNTY OF COMMONWEALTH OF PENNSYLVANIA SS File Number 20/3— ©c)3`I6 J . - 13 Personal Representative(s)of the Estate of_ RAL KPH 4, ®)LFk deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this * ventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney-- (Name) (Supreme Court I.D.No.) (Address) (Telephone) DATE OF DEATH LAST RESIDENCE � FIGURES MUST BE TOTALED Se Ct HOCI-\eJ (Attach additional sheets as needed) TOTAL: 6 7 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may,at the election of the personal representative include the value of each item,but such figures should not be extended into the total of the Inventory. (See 20 Pa.C.S.§330](6)) Form RW-09 rev.10.13.06