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Home My WebLink About11-19-13 _ _ _ ___ . .. ' • � 1505610101 REV-1500 °`�°i_i°, 1� PA Department of Revenue P�nsylvania OFFICIAL USE ONLY � CEPARTMENTOFREVENUE County Code Year File Number � Bureau of Individual Taxes INHERITANCE TAX RETURN "" � PO BOX 28o6ot Harrisbu ,PA 1�128-o6os RESIDENT DECEDENT ENTER DECEDENT INFOR'MATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY � �"��' 2 � ' t � DecedenYs Last Name Suffix DecedenYs First Name MI p �, i n� � � 4 � 2ET � (If Applicabie�Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI � 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 Retum Q 3. Remainder Return(date of death prior to 12-13-82) p 4.Limited Estate Q 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Retum Required death after 12-12-82) p 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) Q 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 Sch.O) . , CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR_. JON SHOULD�IRECTED T0: Name Dayti elephone N� r �� A- /L I 1' � �� S r� �I t:; 7 q `1 v �� OF YINLLS U t� Y � � Q � � � . �"? C�' First line of address � � C► .� '"�'t,„"�'1� "n i q p irn � 2 R i /kc � �f �' ,� N � � Second line of address � � � �Q � � City or Post Office State Zlp Code DATE FILED ■ IIY�I III�II IIIY�I I�II II� � 1M � G �J r 6 � 1� � 1 n p ' � �� Correspondent's e-mail address. 'rR 1 ��3 � ��l�1'�L//11t'�i�Cf�'1 Under penalties of perjury,I declare that I have examined this retum,including accampanying schedules and statements,and to the best of my Imowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF PERSON RESPONSIBLE FOR FILING RETURN DATE ^ � l �-' �� ` t ADD S �1 G � Y'�1��2�i m A�c f�J� �»c=c N�}ti't��4�'i2 Cr /�,�� l��5�.5—. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ' . DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610101 1505610101 J , � 15056],0],�5 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: � ' ' � �,� RECAPITULATION 1. Real Estate(Schedule A). .... . . . .. ...... . ... . . . . . . . . . . . .. . . . .. . . ... . . 1. . 2. Stocks and Bonds(Schedule B) . . . .... . .. . . ... .. . . . .. .. . .. . . . .. . . . . . . . 2. + 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. . 4. Mortgages and Notes Receivable(Schedule D) . . . . . .. . . .. . . .. . . . .. . . ... . . 4. s ^ 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. � ,,� �, `j• ? � 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . . . . . . . 6. .: 7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested.. . . . .. . 7. • 8. Total Gross Assets(total Lines 1 through 7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 � t-�- � . � J 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . . 9. �� , � '- . � �,),� ' 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . . 10. � � � �;, L-� �� .''?� `-�, 11. Total Deductions(total Lines 9 ard 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. � f �' � �� , � �., 12. Net Value of Esta4e(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. �„ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an elecfiion to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. - , 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. �� . TAX CALCULA�ION-SEE INSTRUCTIONS FOR APPLiCABL� RATES 15. Amount of Line 14 taxabie at the spousal tax rate,or transfers under Sec. 9116 - la)�1.2)X.0- , 15. .; 16. Amount of Line 14 taxab!e at lineal rate X.0_ . 16. ,► 17. Amount of Line 14 taxable at sibiing rate X.12 ,� 17. •` 18. Amount of Line 14 taxable at collateral rate X.15 • 18. •' ; > . :.- 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. �� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1,50561�1,05 1,50561,01,05 � � . fitEN-1500 EX Page 3 Fite Number Decedent's Complete Address: �cEO�rs� l�i�- � R C�.� � , �6�..��.N 5 STRE�T ADDRESS � 1°C!' n/!��Z��r►�l G /9�V�c i �� -F��r�CS � �.,. STATE p� �'p 17 vs5 c� Tax Payments and Credits: 1. Tax�ue(Page 2,Line 19) (1) � 2. Credits/Payrnertts A.Prior Paymera�s B.Discount � Total Cr�edits(A+B) (2) 3. interes# (3) C� 4. ff Line 2 is gr�ea#e.r than Line 1+line 3,en#�r the difteerence. This is the OVERPSYMENT. �a��,►�o�P��,U��o m�t a��a. ta) O 5. If Line 1+Line 3 is greater than Lir�2,en#er the difference.This is the TAX DUE. (�) Q Make check payable to: REGISTER OF WILLS,AGENT, PLEASE�►NSWER THE fOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIA�E BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or iryc�me of the property transferred:..................................................................................... ..... ❑ b. retain the right to designaie who shall use the property transferred or its income:............................................ ❑ � c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. 1f death occurred after Dec.12,1982,did decedent transfer properiy within one year of death without receivir�g adequate considerabon?.............................................................................................................. ❑ � 3. Did decedent own an"in trust#or"or payable-upon�leath bank acxoun#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? ......................................................................................................................a. ❑ � IF THE ANSWER TO ANY OF THE AiBOVE QUESTlONS IS YES,YOU MUST COMPl.ETE SCHEDULE G AND F1LE 1T.AS PART OF THE RETURN. �or dates of d�ath on or after July 1,199�4,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use o#the surviving spouse is 3 percent(l2 P.S.§9116{aj t1.1)(i)l• For dates of death on or after Jan. 1, i995, the tax rate imposed on the net vaiue vf transfers to or for the use of the survivir�g spouse is 0 percent [72 P.S.§9116 la)(1.1)tu)].The s#atute does not exempt a transfer to a surviving s�Cwse#rom tax,and#he statutory requirements for d�dosure of asse#s and filing a tax retum are still applicable even ifi the survi�ing spouse is the only t�neficiary. For dates of�at�on or a�er Ju1y 1,2�0: • The tax rate imposed on the net value af transfers from a deceased c�ild 21 years of age or younger at death to or for the use o#a�aturai parent,an adoptive paren#or a s#�parent of the djikl is 0 perc�nt[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use ofi #he decedent's lineal beneficiaries is 4.5 peroen#, except as no#ed in 72 P.S.§9116(1.2)[72 P.S.§9116{a)��)]• . The tax rate impo�d on the net valu�e of transfers to or for the use of the dec�dent's siblings is 12 percent[72 P.S.§9116(a){1.3)j.A sibGng is defined,under Section 9102,as an individual who has at least one parent in cammon with#he decedent,whether by blood or adoption. , ' REV-15o8 EX+(ii-lo) � � enns lvania SCI�IEDI�ILE E � p Y DEPARTMENT OF REVENUE • CASH, BANK DEPOSITS & MISC■ tNHERnaNCe ra,x REruRN PERSONAL PROPERTY � RESIDENT DECEDENT ESTATE OF: FILE NUMBER: j'✓1 f}�2�i4Q� �}, �[�!/��JS - �,O 1.3 _ (7 p 3 Z C7 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 , ,�r°,� � c N-��K:.��- �c � � �`�3,�� -� � . � �.-�' � �8 , f � � � TOTAL(Also enter on Line 5, Recapitulation) $ ,3 �,�5•�� If more space is needed,use additional sheets of paper of the same size. . . REV-1511 EX+(10-06) , � ' SCI�Ep�lLE EI � COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF � FILE NUMBER Yh� (�,G�q.2�''1' 1�-�. �.�� ,",v�� Zo l� ._c�O 3 z-� Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. . � ' �'r�i' �� . r�' �� B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Q�� ( � lt�� 1'�� Street Address Z L a v ✓�'1 L�lZ-� N'�� City 17')�iL l-1 A�1��:5 t��t C�,• State �A' Zip 1 '�o�`s^-- . Year(s)Commission Paid: �� 3 � I / v f�� 2. Attorne Fees Z � � Y (� 3. Family Exemption:(19 decedent's address is not the same as claimant's,attach explanation) � � . Claimant Street Address �. � � 3 ''� � City State Zip Relationship ofi Claimant to Decedent �� 4. Probate Fees � �(� 3 ,�� V • � 5. Accountant's Fees � � � 6. Tax Retum Preparer's Fees v 7. f TOTAL(Also enter on line 9,Recapitulation) $ 2�y, �3 (If more space is needed,insert additional sheets of the same size) � ' ` REa/-1512 EX+(12-08) - � eRnns lvan�a � SCHEDULE I - R y DEPARTMENT OF REVENUE DEBTS OF DECEDENT� iNHerurANCE Tax REruRN MORTGAGE LIABILITIES 8� LIENS RESIDENT DECEDENT ' . ESTATE OF � FILE NUMBER m�-r��.-� �-• �Z D�L �NS a o, -� - ��3 �-o Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ��r r��T. o t= �U � �.,�� w�� ,=�-rL.E . � a i� � �� . .�3 , �.�. �� ,� �: ;� �, � ��.� .�' . a -��: � � � ��'i � y,�.��. TOTAL(Also enter on Line 10, Recapitulation) $ � "�� L{� , 3 If more space is needed,insert additional sheets af the same size. ( • � � REV-1S 13 EX+(01-10) � pennsylvania - SCHEDULE � DEPARTMENT OFREVENUE INHERITANCE TAX REfURN BENEFICIARIES RESIDENT DECEDENT i ESTATE OF: � FILE NUMBER:. 4�'� �-�/9�Z��'-� �-- �� l� i�l S RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND A►DDRESS 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).] i. �1412i i�le� �', �lc=�,St�N N' 1 �� '��c.s "21 �� IM C RR.��F C�t1 C� m�c��ti�cs��2�- �/-� ��oss— �,,,,� ��Y �t��4�eN 2 ,�"�f�y f2� n/��.Sa�v j{V S� Zt �l�t�n�1��r`sr� � v't�� /�J�� Y►'1 L`G/�i�►-�v��SQ�°�6 1�i417 fJ S`S , � l C�N f/y �1�1�}—ieLr � 3, /V 0 �2r�i�A� ��I S�S�i e� l�f'l.C t�7 C�a � �ao �v�-G-�r�N �R �ct t 7 t�'►?v 2�� /YI i0. Zt?�� . t „ s �- �/� S f�f�-12�L � r S t1 S/+nl � �� /C1 j L �L �D r3oX �� 2y /2�Q �ad�-c� yn i ��t�a , 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: O 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.