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J 1505610105
REV-15000 urc- (R)
OFFICIAL USE ONLY
PA Department of Revenue pannsytvama County Code Year File Number
Bureau of individual Taxes INHERITANCE TAX RETURN t
PO BOX 28o6oi I I
Harrisburg PA 1712"601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
011182012 02/0611931
Decedent's Last Name Suffix Decedent's First Name _ MI
Gagliano Salvatore J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Gagliano Frances C
spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
151-24-2392 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
COD 1, Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4.Limited Estate O 4a.Future interest Compromise(date of O 5.Federal Estate Tax Return Required
death after 12-12-82)
C=3 6,Decedent Died Testate C=) 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C:) 9.Litigation Pmceods 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 TO:
Name Daytime Telephone Number
Howard Azrolan (908)X42 8761 � a�
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RM R OF JUSE GALS
m ro c cn t2
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First Line of Address _ ;0 3, r— � M rn
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95 Freeport Blvd to ;x; a
Second Line of Address :�i, -C,n Z3 _ ,7
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Q
City or Post Office State ZIP Code OATS F E y Cf
Toms River NJ 08757
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best or my knowledge and belief,
it is true,correct and complete.Declaration of preparer of r than the personal representative is based on all information of which preparer has any Knowledge.
SIGNATURE,aPE�RSON RESPONSigI.E FOR F RET��N' / PATE
ADDRESS � v�--
397 Baker O e Mechanicaburg PA 17055
SIGNAIU E OF RE OTH THAN REPRESENTATIVE DATE
/ � u�till$
ADDRESS `
95 Freeport Blvd Toms River NJ 08757
PLEASE USE CNUGINAL FORM ONLY
Side 1
1505610105 1505610105 J
Yv
J1505610205
REV-1500 EX(FI)
Decedents Name: Salvatore JI Gagliano
RECAPITULATION `
)
1. Real Estate(Schedule A). ............................................ 1. l
2. Stocks and Bonds(Schedule B ..... ... " 2.i
3. Closely Held Corporation,Partnership or Sole-Pmprietorship(Schedule C) ..... 3.
I
4. Mortgages and Notes Receivable(Schedule D)........................... 4. i
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. t
7. Inter-Vitus Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
0.00 )
8. Total Gross Assets(total Lines 1 through 7)............................. 8.i
9. Funeral Expenses and Administrative Costs(Schedule H)...... 9. I
I
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.
11. Total Deductions(total Lima 9 and 10)................................. 11.1
j
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14.
0.00
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
j
at the spousal tax rate,or
transfers under Sec.9116 1 15 !
(ax1.2)X.0-
j 16. Amount of Line 14 taxable 16
at lineal rate X.0_ _J
17. Amount of Line 14 taxable 17
at sibling rate X.12
18. Amount of Line 14 taxable
at collateral rate X.15 l
O_1
19. TAX DUE ..........................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
C=
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Salvatore J Gagliano
STREETADDRESS
397 Baker Drive
CITY STATE 2rR
Mechanicatrurg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. if line 2's greater Nan Line 1+line 3,enter the difference. This is the OVERPAYMENT.
Fill in Oval on Page 2,Line 29 to request a refund. (4)
S. if tine 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
I. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... 0 0
It. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest.....-.................---.............................................................................................- ❑ ■
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑
2. If death occurred after Dec.12,1992,did decedent transfer property,within one year of death
without receiving adequate consideration?...................._...................._.....-..................................,................._..... ❑
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 '
containsa beneficiary designation? ........................................................................................................................ ❑ N
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.1,19%,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)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)(fl)),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)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)1.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.
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