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Home My WebLink About02-10-14 . � 1505610101 REV-1500 �`01_1°> � -*?,:1;�L U3c i:�Jl_Y PA Department of Revenue pennsylvania Bureau of Individual Taxes `P�p'�E»' F Counry Code Year File Number PO BOX 28o6oi �ptNHERITANCE TAX RETURN DD Harrisburg,PA i�iz8-o6oi RESIDENT DECEDENT �� ENTER DECEDENT INFORMATION BELOW ' Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY � C� I O c� ,�� a � �' � l l I � I �--1 D e c e d e n Y s L a s t N a m e Suffix DecedenYs First Name Ni� S � 0� E ivl Nl � L� l� % ,2 C� 1 /V� t ✓-� C=. (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� 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 � 2. Supplemental Return � 3. Remainder Retum(date of death prior to 12-13-82) , � 4. Limited Estate :,� 4a. Future Interest Compromise(date of '� 5. Federal Estate Tax Retum Required death after 12-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9. Litigation Proceeds Received �J 10. Spousal Poverty Credit(date of death � 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 INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number � C�.. c� �( i N- iR � c� ovk : `� � -7 s� � .�aSs �EGISTER�O,F�WIL��ONLY � _ � S n � � � 1 First line of address y,. � f—'' � �3 i _ � 1 � l,c�� S T � 1 / � U tc� S t� � rn � � �' � '� �" �� i Second line of address � �" � - *y _„ ; f..j C7 -•�'j : C"i i /1 � � � iO �° � � t"rt ; �� . ;.,, _ ; � ' � Ciry or Post Office State ZIP Code '� �-�--�='�F�L �� C � F� Li S � � � �_ �i � �o �r� � CorrespondenYs e-mail address: Under penalties 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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE � - - � C`�-��Z a- �� -i�- AD ESS �l� u� i,v.�� ,� SIGNATURE OF PREPAR�OTHER THAN R RESENTATIVE DATE (,�,��,C,.�,.�� { G`--'n �7 0�3 ADDRESS � PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610101 1505610101 ,� f � 15056101�5 REV-1500 EX Decedent's Social Security Number DecedenYs Name: �/(,� � � r�l�G�..�� / � � RECAPITULATION 1. Real Estate(Schedule A). ..... . .......... .. .. ... .. ....... .. .... . . .... 1. U' (� O 2. Stocks and Bonds(Schedule B) .... .. .. .. .. .... ... ... ... .. .. ... . . ..... 2. � • U D 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .... 3. � • U D 4. Mortgages and Notes Receivable(Schedule D)....... . .. ... .. .. .. . . ...... 4. Q• O O 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .... 5. ,�� 3• � � 6. Jointty Owned Property(Schedule F} r� Separate Biliing Requested .... .. . 6. Q ' p D 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ` ` (Schedule G) � Separate Billing Requested.. .. .. .. 7. Q• Q D 8. Totaf Gross Assets(total Lines 1 through 7). . .. .. ... . . . . .. . . .. .. . . .. . .. . 8. � � � � 3• �- � , 9. Funeral Expenses and Administrative Costs(Schedule H)..... ... . .. .. ... .. . 9. O . (7 O 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . .. . ... .. .. . .. 10. 4� D � 11. Total Deductions(total Lines 9 and 10)... .. . . .. ... .. . . . . . . . . . . . .. . . ... . 1L (�•�� .z r.�. -. �-, . 12. Net Value of Estate(Line 8 minus Line 11) . . . .. . . . .. . . .. .. . . .. . . . .. ... .. 12 ,`�`� ��6 3 •° ��p ��: ,�,a..-�= ,.. . ��; 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which " °f °� �` ' "' �' an eiection to tax has not been made(Schedule J) . . .. . . . . .. . . . . ... . . .. . .. 13. � b• � � . >x� �, �, �. � � , r , 14. Net Value Subject to Tax(Line 12 minus Line 13) ... . . .. ... .. . . .. .. .. ... . 14. �.� �0 3�y�-T � TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sea 9116 � � �� °� �� " � �� ` � . . .: .� _. r,. �. � �a)�1.2)X.0- � 15. � ; 1 � °-�-"��'�,�,,� x 16. Amount of Line 14 taxable (°j ` /" ' ` 1L at lineal rate X.0� �� S Z5 � � �/ b �6• � � 7 � '� �� 17. Amount of Line 14 taxable �� _ ��" ��a�� x ��4��s� at sibling rate X.12 `� »• `� 3�.., a"�� .��.��"��.� � x,. � .„'a y�s�';: �,¢. ;�.%� 18. Amount of Line 14 taxable � at collateraf rate X.15 • �g• ' ' „ �_. � .x. � .._. ;�� ,. _� F ._. .�°�_,�.��; � _.��:��`a��=� 19. TAX DUE . ... . .. .. .. ... .. . . . .. .. ... . .. . .. ... .. .. .. ... . . . . .. .. . . . . . 19. ' r, . .v: '� �_�-_ �._ _��..��Y,,_:� 20. FILL IN THE OVAI IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT rJ Side 2 � 15D561�1�5 15�5610105 ,� REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENTS NAME U/�6 i�(I/� t� ,Sr�Ffn�� ----- STREETADDRE,�s �/ `��rf l�i __�f� -P Nlt � f�D/Yl�, ��/�/R�i> /j"JG��'(�2 _ — �i� ��c S f� ' - CITY ', STATE I ZIP � �� ' �� Ta�c Payments and Credits: 1. Tax Due(Page 2,Line 19) ��) / ��=� ` D � 2. GreditslPayments L? �G, A.Prior Payments �_ B.Discount . � �C Total Credits(A+B) (2) �� - l � 3. Interest (3} 4. If Line 2 is greater thart Line 1+Line 3,enter the difference. This is the OVERPAYMENT. Fill irt oval on Page 2,Line 20 to request a refund. (4) 1 � 5. if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) / l �� Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BtOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the propertyr transferred:.......................................................................................... ❑ �,-r� b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ 11� c. retain a reversionary interest;or.......................................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... � � 2. If death occurred after Dec.12,1982,did decedenE transfer property within one year of death without receiving adequate consideration?.............................................................................................................. � � 3. Did decedent own an"in trust fo�"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individua!retirement account,annuity or other non-probate property,which ❑ � containsa benefidary designation? ....................................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE!T 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 impased 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 disclasure of assets and filing a tax retum are stilt 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 deattt 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 decedenYs lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a}(1)]. + The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3}].A sibling is defined,under Section 9102,as an individuaf who has at least one parent in common with the decedent,whether by blood or adoption. i+�i�v-��,��8 EX+(i�-io) I , •. �CHEDULE E �� pennsylvania � oePaarMeNr nF F�r ver�ue � CASH, BANK DEPOSITS & MISC. ;i+r:ttrrnrvice rnx i+tTUaN PERSONAL PROPERTY "r_�tor�Nr��ec�oEUr � ESTATE OF: FILE NUMBER: I�i�61n116� �• S�i�"i�'��d�'lF � -- 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. iIFM VALUE AT DFlTE PJl1ME3ER DESCRIPTION OF DEATH I I��iV �-c� j=' � 9�S6�7o 3 S/ -�YJ �r � /?��4c�1/� �� s�. �(� �• �� /�o . a, C(%��c �i�� c� � � ��6 i s f6�o� �" ✓� �' 7 �y Nl� �� J �-,�� 7 P��r i� �'j 7, f-/o LL S r2�S ��f�n�C'o-� �� ; y ��. � , �-r iY ��. �-��iy ��5 , �� o�s �j��c�s %� f�� As v� i�� Te �'`� I�Fr1-i(-1- . TOTAL(Also enter on Line 5, Recapitulation) $ a�7� S �`�-�(�c If more space is needed, use additional sheets of paper of the same size. ��:i!V�1',I) EX� (i)1 ltl) 4 � �� pennsylvania � SCHEDULE J rno-Hirnr��_e r��x r.rrui�rv BENEFICIARIES :�I_�IUENf I��CCI7ENI ESTATE OF: FILE NUMBER: j�I dQ�t lr�( t��- � . S��f'v"h fh �' � RELAiIONSHIP TO DECEDENT ;;h10UNT OR SHARE >lU��iBER "IAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) UF ESTATE I �,4XAk3LE D[STRIBUTIONS f Indude outriqht spousa�distributions and transfers under '��c. 9116(a1 (1.21•1 j I L � lU IY) /i7 ,� "�fSdV�. ��`�?��1.� � �Z�. � � f � � �� lf � � � �, rl� � S�t, � <�/�s� �.sh �-�� r�� LrS�� %�� ,�� r j (� :�� 7 � I �. ` C�„��4 S�� s��mm� � s�',�c��rer� �A��► t�� i�� e � ; � f ��-�- /��j �� lC. S l o �7 S- ,..� s�i�4-/L� A-�c T ��SS s� ��a �'o/c>�v �cJ A c i-! '�� 11, �-�1. 73 �� 3�5/ 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.