HomeMy WebLinkAbout01-06-14 � 1505610101
REV-1500 °`�°i_1O, �
OFFICIAL USE ONLY
PA Department of Revenue pennsylvarria County Code Year File Number
Bureau of Individual Taxes OEVARTMENTOFpEVENUE
PO BOX 28o6ot INHERITANCE TAX RETURN �
, Harrisbu ,PA t�128-0601 RESIDENT DECEDEI�IT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
3 1 � ,
Decedent's Last Name Suffix Decedent's First Name MI
� `� � �
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
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Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Q 1.Original Retum � 2.Supplemental Return Q 3. Remainder Return(date of death
� prior to 12-13-82)
Q 4.Limited Estate p 4a.Future interest Compromise(date of Q 5. Federal Estate Tax Retum Required
death after 12-12-82) _
Q 6. Decedent Died Testate Q 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
p 9.Litigation Proceeds Received p 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
befinreen 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPOND�NT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFQRMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Nu
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First line of address
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Second line of address � � w' � �
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City or Post Office State Z!P Code
. DAT�LED �
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Correspondent's e-mail address:
Under penatties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true, and oomplete.Declaration of prep r other than the personal representative is based on all inforrnation of which preparer has any knowledge.
SIGN U OF PERSON RES ONS E OR G R UR ATE ��
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610101 1505610101 �
� 1505610105
REV-1500 EX
Decedent's Social Security Number
DecedenYs Name: '� � � � � �`+"`"��
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . . . . . .. . . . . .. . . . .. . . .. . . . . . .. . . . . . . . . . . 1. L'•
2. Stocks and Bonds(Schedule B) 2• �'
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. �*
4. Mort a es and Notes Receivable Schedule D �'
9 9 � ) . . . . . . .. . . . . . .. . . .. . . .. . . . . 4.
, � 3
5. Cash, Bank Deposits and Miscellaneous Personal Property{Schedule E). . . . .. . 5. � �� � 1 6 +
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. ' '�+r
8. Total Gross Assets(total Lines 1 through 7). .. . . . . . . . . . . . . . . . . . . . . . . . . . . 8. � �� �s�, � . � ��j'
; , . ��
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . .. . . . . . . . . . . . 9. � `rt��� ��s
10. Debts of Decedent, Mor# a e Liabilities,and Liens Schedule I 10. ' ' G:
9 9 � ) . . . . . . . . . . . . . .
�, �� �
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. � �f„S �f �.
. 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 12 "�j � � � � ,��p J
13. Charitabie and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. L•
/ ��
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . .. . . . . . . . . . . . . . . . . . . 14. � � � � �.LQ �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 `
(a)�1.2)X A-. C� ,� <j" 15. �'.� �
16. Amount of Line 14 taxable , , �-, G�
at lineal rate X A_ � � � � . �� 16. � � l • � �
: �
17. Amount of Line 14 taxable ' S ' `
at sibling rate X.12 G�,�w��.; 17. ` ��' �
18. Amount of Line 14 taxable
at collateral rate X.15 � •� � 18. �� �
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19. TAXDUE . . . . . . . . . . . . . . . .. . . ... .. . . .. . . .. . . .. . . . . . . .. . . . . . . .. ... . . 19. '; ? `: � �' ! �� � :
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
� 7,505610],05 1505610105 �
REV 1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
��' � C�,a..r'T� '�(.�,�.�.
STREET ADDRESS �
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CITY �� " t'� ���" � ST�� ' / �O zj� � � � , �.�,
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Tax Payments and Credits:
1. Tax Due(Paqe 2,Line 19) (�)
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Intere,st
�3)
4. if Line 2 is greater than Line 1+Line 3,enter the difference. This is the QVERPAYMENT. �
Fip in oval on Page 2,Line 20 to request a refund. (4)
5. if Line 1 +Line 3 is greater than Line 2,en#er the difference.This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE F4LLOWING QUESTIONS BY PLAClNG 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 the right to designate who shaii 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. If death occurred after Dec.12,1982,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 acx�unt or security at his or her death?.............. ❑
4. Did decedent own an individual retirement acxount,annuity or other non-probate property,which .
contains a beneficiary designa6on? ........................................................................................................................ � ❑ �
IF THE ANSNItER TO ANY OF THE ABOVE QUESTlONS{S YES,YOU MUST COMPLETE SCHEDULE G�►ND 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 af transfecs 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 af tr�nsfers to ar for the use of the surviving spouse is 0.percent
[72 P.S.§9116(�)(1.1)(ii)].The statute does not exempt a transfer fo a surviving spouse from tax,and the statutory requirements for disdosure of assets a�d
filing a tax r�tum are still appiicat�e even if the surviving spouse is the only ber�fiaary. _
For dates of death on or after July 1,2�:
. The tax rate impased on the net value of transfers from a deceased chi{d 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent af the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of Vansfers to or for the use of the decedent`s linea! bene#i�iaries is 4.5 percent, except as noted in
72 P.S.§9116(4.2)[72 P.S.§9116(a)(1)l•
• 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 ir�ividual who has at least one parent in common with the decedent,whether by b{ood or adoption.
-.
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REV-1470 EX(01•10)
»:
�:a,`N i'ef��e. • .� .
�:��Y��� � � pennsylvan�a INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280601 .
DECEDENT'S NAME . FILE NUMBER
Sandra K.G�ttshall 2113-0611
REVIEWED BY . ACN
J Collins 101
ITEM
SCHEDULE Np, EXPLANATION OF CHANGES
Decedent was survived by her parents.Taxable at the lineai rate of 4.5°/a.
E 1-4 Jointty heid assets are.correctly reportable on Schedule F. ';�
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Indude ttte prooeecl�af�on a�t t�e d�e t#�prooe�s were reoeived by the esta�bee.
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ITEM - � VAWE AT DATE
NUMBER DESCRIP`TION OF DEATH
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vEffiCLE OWNED SOLE�,Y BY THE DECEASED OR BY THE DECEASED
� AND ANOTHER PERSON�AS TE1�A1�tT3 IN C4M�M4N
Family F,zemption � _ _ _ • . .
� � W'hen a surviving spouse or child or parent of the same househoid of the deceased claims a
vehicle as the whole ar part of the family exemption u�der Section 3122 of the Probate,Estates
and Fiduciaries Code(ZO PS C.S.3121),she/�ie may assign the title to the new-owner.Attach the
following: �
1. Titie '%�,�� �,, �, �:� � .
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a.� Assigned by the executor,administrator or the person�s)entitled to family exemption.
2. Affidavit of entitlement under 20 PA C.S.3121 •
3. Completed Form MV-4ST f��� ���Q.��3 lt�"�'" �.. ��1��'1. ��T�'�
1�'U'/E'/Yt S1 1f�'f't tr'��'� /�YStl�`�1��`�c j C.�1..�..� � �� ,�R�L."5
. 4. F�S ?-�+x -�t�� r3u��r� f'tl-t�-�� �"'� c s �Q e��t��-fl
a. $22.5��itle fee if being titled in any other name a�er than a surviving spouse
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. i. _No�°fee r�quired if the.vehicie is being titlod solely in the name of the
surviving spouse -
ii. �6.00 transfer fee or appropriate regis�ration fee,whichever is applicable
� iii. Appiicabte sales tax,if recluired•
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