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HomeMy WebLinkAbout11-18-13 (2)=- � �� : ���Sb7��1��, � � , REV-150:0 °`�o�-1Q' � OFFICIAL USE ONLY PA Department of Revenue P����a County Code Year File Number oEwwn�errt oF�rtxue Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi Harrislwrq,PA��128-o6ot RESIDENT DECEDENT ENTER DECEDENT INFORMATfON BELOW Social Security Number Date of Death MMDDYYYY Date�f 8irth MMDDYYYY t 0 ..� �����������.���� ���_ ���. �, . �..� � - � 1� = Decedent's Last Name Suffix Dece�::nYs First Name MI � (If Applicable)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 Retum p 2.Supplemental Retum p 3. Remainder Retum(date of death prior to 12-13-82) p 4.Limited Estate p 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Retum Required death after 12-12-82) p 6.Decedent Died Testate p 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 p 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) beiween 12-31-91 and 1-1-95) (Attach Sch.O) CORRE$PONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name. Daytime Telephone Number � L � � � , - : �GiSTER�WIL� r.ONLY � � � �C/! :� First ltt�e of address � � � M rn �j �7 � �3 � � � � ' � � p `� '`�'1 "'� ;: � Second line of address � � � ;� � - . � N � rn r � City or Post Office State ZIP Code TE� �III.. � �������IiY�Y��i�� �J ��r,• % s Correspondent's e-mail address: � Under penalties of perjury,I dedare that I have examined this retum,including accompanyin "edules and statements,and to the best of my kn ge and beiief, it is true,correct and complete.Declaration of preparer other than the personal repre tive is based on all information of which preparer has ny knowledge. StGNATURE OF S N RESPONSIBLE OR FILING RET ., � , A RESS , 1 ��O ^ � � rl� . v� (� . oc SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 150561D101 1505610101 � 1'505610105 - REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION n�I 1 Li . Real Estate(Schedule A). . ... .. .... ......":. '{ ~D-' f J 2. Stocks and Bonds(Schedule B) .... . .... ....................... ....... 2. Ll- LiI 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... .. 3. uL- LI` �JU�, I._.- - 4. Mortgages and Notes Receivable(Schedule D) .......... ............ .... . 4. 1��J� �11 AL 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 51;'n I •,�' 11 6. Jointly Owned Property(Schedule F) p Separate Billing Requested ..... .. 6. _JI i 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property -- 1 i• Schedule G p Separate Billing Requested........ 7. I �' 8. Total Gross Assets(total Lines 1 through 7). ........ . ..... 8. �� _ © .ppJ� 9. Funeral Expenses and Administrative Costs(Schedule H)....... .... ....... . 9. �� , ��; ?{ b 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1).. ....... ..... 10. 11. Total Deductions(total Lines 9 and 10)........... .... .... ........ .. .... 11. 2-Lil �� � 12. Net Value of Estate Line 8 minus Line 11 .. .... ... 12. l' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .... ....... . ... .... .... 13. 1 40 14. Net Value Subject to Tax(Line 12 minus Line 13) .... .... .. .. ........... . 14. 17' TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES u{ Q 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0- I ).� 15. Li 16. Amount of Line 14 to le at lineal rate X.O a jJLJ ll ul 7�✓��.�� 16. 17. Amount of Line 14 taxable I sibling • at 18. Amount of Line 14 taxable +-E :. ., at collateral rate X.15 �✓-J � 18 G 19. TAX DUE ......... ......... .... .. ..... ......... ....... ............ 19. i 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610105 1505610105 J REV-15o8 EX+(il-1o) �. en�s lvania SCI�IEDVLE E ' p y CASH, BI�NK DEPOSITS & MISC. DEPARTMENT OFREVENUE INHERITANCE TAX RETURN PER�7ONAL PROPERTY RESIDENT DECEDENT TATE Of: FIL NU B R• �� �� -1 - � / 'l , Include the proce 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 DESCRIPTI OF DEATH Q� .� �X.-- � C.�� � �� V ��) � D �/ / TOTAL(Also enter on Line 5, Recapitulation) $ �Q `�.� � If more space is needed,use additional sheets of paper of the same size. � _ _ __�_ __ _ _ — _ � .. REV-1511 EX+(10-06) , SCi�IEptILE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & � INHERITANCE TAX RETURN ADMINISTRATIVE COSTS � I � � � 1 � RESIDENT DECEDENT � ' TE OF � FILE NUMBER �'� �� Debts of decedent must be reported on Schedule L ITEM • NUMBER DESCRIPTION AMOUNT � A. FUNERAL EXPENSES: �, . •` � �. � � v ./ o . a � l v B. ADMINISTRATIVE COSTS: 1. Personal Representa#ive's Commissions Name of Personal Representative(s) -- Street Address City State Zip Year(s)Commission Paid: 2. Attorney Fees � 3. Family Exemption:(If decedent's address is not the same as claimanYs,attach explanation) , . Claimant Street Address City State Zip , Relationship of Claimant to Decedent . /� 4. Probate Fees , �S O V 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. . ; � ���4 v TOTAL(Also enter on line 9,Recapitulation) $ (If more space is needed,insert additional sheets of the same size) REV 1500 EX Page 3 File Number � i j � ' �/'� � � 1 D�eden�`s Complete Address: � s � L � . S�Q,rz_ -Z_ S ETADDRESS C�00 vv� . CITY STATE P {�,�� : � '�O t 3 Tax Payrnents and Credi#s: 1. Tax Due(Page 2,Une 19) (1) �Q l - � 2. CreditsJPayments -— A.Prior Payments B.Discount Total Credits(A+6) (2) 3. interest �3) 4. If Line 2 is grea#er than Line 1+Line 3,enter the difference. This is the OYERPAYMENT. Fill in oval on P�2,Line 20 to request a refund. (4) _ 5. If Une 1 +Cine 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) �Q �� � j7...."� Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSiNER 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:........................................ .................................................. b. retain t1�right to designate who shaN use the property transferred or its income:............................................ ❑ c. retain a reversionary interest;or.......................................................................................................................... ❑ ' d. receive the pmmise ior life of either payments,benefits or care?...................................................................... ❑ 2. If death occurred after Dec.12,1982,did decedent transfer property within one year o#death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decsdent own an"in trust fa"or payabie-upon-death bank account or seaarity at his or her death?.............. ❑ 4. Did decedent own an individual retirement acxount,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ IF THE ANSVYER TO ANY�F THE ABOVE QUESTIONS!S YES,YOU MUST CO�IPLETE SCHEDULE G AND FILE IT AS P14RT QF THE RETURN. for dates of death on ot after Ju1y 1,1994,and before Jan.1, 1995,the tax rate imposed on the net waiue of transfers to or for the use of the surviving spouse is 3 penc;ent[72 P.S.§9916(a)(1.1)(i}l• For dates of death o� or after Jan. 1, 1995, the tax rate impased on the net value of transfiers to or for the use of the surviving spouse is 0 percent (72 P.S.§9116(a)(1.1)(ii)].The statute dces rrot exempt a transfer to a surviving spouse from tax,and the stat�tory requirements for disdasure of assets and filing a�ex retum are still applicat�e even if�he surviving spouse is the only benefiaary. � � � For date.s of death on or after July 1,2400: • The tax rate imposed.on the net value of transfers from a deceased chik! 21 years of age or younger at death ta�or for the use of a natural parent, an adoptive pareM or a stepparent of the d�ild is 0 percent[72 P.S.§9116(a){1.2)j. • The tax rate� imposed on #he net value of transfers to or for the use of the dec:edent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9916(a)(1)]• • The tax rate imposed on the net value of transfers to or for the use of the dec�denYs siblings is 12 percent(72 P.S.§9116(a)(1.3)�.A si�ling is defined,under Section 9102,as an individual who has at least one parent in common with the deoedent,whether by blood or adoption.