HomeMy WebLinkAbout02-07-14 � �1505610105
REV-1500°`��_��,��
OFFICIAL USE ONLY
PA Department of Revenue P���e
Bureau of Individual Taxes �������MUE Couniy Code Year File Number
�O�Ox 28osoi INHERITANCE TAX RETURN
Hantsbu PA 1 s28-o6ot RESIDENT DECEDENT �� � /O
ENTER DECEDENT 1NFORMA710N BELOW
Soaai Security Number Date of Death MNIDDYYYY pate of Birth MMDDYYYY
� y a S a�i3 �3 i� �417�
DeoedenYs Last Name Suffoc DecedenYs First Name MI
{�D K� _ _ _ . _ ��SS l �� �►
(If Applicable)En�Surviving Spouse's Infonr�ation Below
Spouse's Last Name Suffoc Spouse's Frst 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.Suppiemental Retum O 3. Remainder Retum(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Retum Required
death after 12-12-82)
O 6.Deoecient Died Testate O 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proc:eeds 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 Oj
, CORRESPONDENT-TfMB SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SHOULD BE q1�,�CTED T0:
Name Daytime hone Num� �
._ __^ _ _ �P s- � t"�'i
I-ct,��,IGI� /�- �� �°✓' 7'/7'��,,�b7""��°'��j �
' y t�
�� � ,
QI��Y�LS USE ONHY'�
3'�► I'"�ri ��'1
A � � -J :.�3t�
First Line of Address :� � � G► a
1 �y s� !�i _ s �,e�� -� � " � -� -� -�
_ � � � � � ��
..�.
�, �' _�� c�
Second Line of Address � ;.tz --� �""' !"�"t
� �""' Q
� � � �
City or Post O�ioe State ZIP Code DATE FILED
C ���° ���-1- Px�- �;� t I
Care�pa�dern's e-mail address:
Under penal0es af perjury,I declare tl�at I hav�e eo�rdned tlrs retum.i�dirr9�Y�9 sche�les and s�err�,and to the best af my Iv�owledge s�d belief,
it is true,coRec�and complete.Dedara�a�of preparer olhe�than the pers�al�tNe is based on all iniormaati�on�fi which preparer t�as amr knawledge.
OF PERSON BlE FOR FIUNG RETURN DATE ;
` ����
,�ce
noor�ss
� .��`��l w �i S P P �,ct. �� ��T I.�� � �
SIGNATURE OF ARER OTHER THAN REPRESENTA DATE
,..� �N�►�, r
ADDRESS
P�EA�SE USE ORiGINAL FOR�iI ONLY
Side 1
� 15056101�5 150561D105 �
. =
� 15056102D5 -
� -
REV 1500 EX(Fij p��t's Social Se�rity Number
__.
_ _ .
__ __ _
� ��-
Dece�JenYs Name:
RECAPITULATION _ _
�!. Reai Esta�(ScheduleA). ............................................ L __ . ._ ""� '', .
a
2. Stocks and Boncis(Schedule B) ....................................... 2. ""' _ _.
O
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. . . -�
c� "''
4. Mortgages and Notes Receivable(Schedule D}......... . 4. ""� __ _.
5. Cash,Bank Deposits and Misoelianeous Personal Property(Schedule E)....... 5. : ��-J g}Q�C��.�,�p ._.
6. Jointly Owneci PropertY(Schedule F) O SeParate Billing Requested ....... fi. ,.-�o "-�
7. lnter-Vrvos Transfers 8 Miscetlaneous Non-Probate Property _
�
(SchedWe G) O Separate Biliing Requested........ 7.
r
8. Tot�l Gross Assets(tot�Lines 1 through 7)............................. 8. j �� OJ��� ��
8. Funerai Expenses and Administrathre Costs(Schedule H)................... 9. /'o�. �.a,Q�. ��._, .
._ ._�.
_ I. � �
10. Debts of Decedent,Mortgage Liabilitles and Liens(Schedule I)............... 10. � �,>�'�j�, _. _. �
f�..�. ,
11, Totai Deductions(totai Lines 9 aatd 10}................................. 11. �� _� �r_.,._ �.__.,. _„
� �$g � 7 -�:
-12. Net Valus of Estate(Line 8 minus l.ine 11).............................. 12. �' 3 �(� 1 7'Q _ � . _...
�."� _.._.'�.. ...
13. Charitable and Govemmental BequestslSec 9113 Trusts for which
an etec�on to tax has not been made(Schedule J) ......... .. 13. �� `�'
14. N�t Vs(ue Subject to Tax(�ine 12 minus Line 13) ........................ 14. � 3 y �' 7'Q G7 �
.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Une 14 taxable
at the spousal tax rate,or _ _
frar�sfets utxler SeC.9116 _
(ax1.2)X.0� 15. ""' � "'r
16. Amourrt of Line 14 taxable ` .__ _
at tineal rate X.0_ _ 16. ��"7 _ [ ��.�-��
17. AmouM of Line 14 taxable � ..,,,� .. _
at sibGng rate X.12 17. -d
18. Amount of Line 14 taxabie _ _
at coitaterai rate X.15 �g- '"�D _ l
19. TAX DUE......................................................... 19. f. �� �.O�t' _ __
4P � ..�-
J '
20. FILL!N THE OVAL IF YOU ARE REQUESTiNG A REFUNO OF AN OVERPAYMENT �
Sid@ 2
�
1505610205 150561�205 ,�,J
.
� REV 1500 EX(FIj Page 3 FNe Numbsr
Decedent's Compiete Address:
DECEDENT'S NAME
�c 5s�'�g �'I'') . �l-�D 1��;
STREETADDRESS
/ �`� /-�1 w �/LP p'�'
CITY �, i STA ZIP
Caz.w. N�� �j}— �7�1�I
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (�l � ��3 �3
2. CreditslPayments
a Prior Payme� _
B.Discour�t
Tot�l Credits(A+B) (2) �° �
3. Inte�est
f3� .�d
4. If Line 2 is gre�er ltren Line 1+line 3,en�er the di�erence. This is the OV�PAYMENT.
FlN�enral on Psge 2,LMe ZO�o requeat a retund (4) ,�c� —
5. If L'me 1+Line 3 is greater tfta�t Line 2,eft�r the difber�enoe.This is the TAX DIJE (5) Cr B �3� (�SJ
Make check payable to: REGISTER OF WILLS,AGENT.
+�'�';;:.*....,._. ., ....� ..�rr*. <.�n�,.+',.'� x�.z:r r m� :.��.��-^r r..�,:.� f w'kF'T..: �� �- �3„ ss '�ac'� ,��� -�� s :ri•:-r- 1,.�5"£.a���, °�"'�°%- �y"��'ax.:,'.,�s$�'' ..,��v°1L�;"fX
'S;4� .... . . .. ."'� „.`C�,``u.�'�"��'„���°*�Al �a �'�1 z 4��t S' '�r��u� 1 Y��, v^t°c� # : k"'� _;'�f 3 i'ne-``��„'�..+�``����F ��,x��.'�i��.�+,'`.'rr.i��t�'k�-��.., �` .
.. .�.9x..nm.�.s� �...-�_..s rc"_ �:.�...,�rs.5��.'F"�rr�s',�.�.,_as.._a2f�ax:: ., .,«w .�#. . d;�e: . .
PLEASE ANSYVER THE FOLLOWIHG QUEST�NS BY PLACIHG AN"X"IN THF APPROPRIATE BLOCK�
1. Did d�t n►ake a hans#e�and: Yes No
a. r�ain the use or inc�ome of the pro{�eriy transfemed.........:................................................................................ ❑ �
b. re�ain the rigM to designafie who shaM use ihe p�operiy trar�emed or its income............................................ ❑ �
c. re�ain a reversior�ary interest.............................................................................................................................. ❑ �
d. r�ec�e�ve the pr�orr�ise�Or bfe�either p��he�s or c�e?...................................................................... ❑ (�
2. ff dea�occurr�sd after Dec.12,1982,dd deoedent tra�r property within one yeat o�d�ath
witl�out receiving adequa�e consideration?.............................................................................................................. ❑ �
3. Did deoedent awn an'�n hust for'or payable-uporEdeath bardc aoc�mt or security at t�s or t�er d�lh?.............. ❑ �
4. Did deoedent awn an individual�tirernent aooau�t,ar�uiiy or oth�non-probate property,which
contains a beneficiau'y designation? ...........................................................................................•............................ ❑ (�
IF THE ANSYIIER TO ANY OF THE ABOVE t�IIEST�NS IS YES,YOU I�llST COMPLETE SCHEDULE G AHD FlLE R AS PART OF THE t�TU1�1.
�,`�„,. .,.. . ���.`� ,��arr"�tSS,.�-'x�F4��� �S� �s:.��. ����'��r-�� �s�.� �rti:_; � :�£,.�» �#'� 7'��: �''�'€���.j(�z�s;t �-'�g�'�
%�"" ..��*�*,-�-�:�..�£`x�`.�$�a � � .z..ti_,.k ` Xt,-�`.. r Ys%�,��. ��..����.k;�"5���:.".E.�-s�"��u.,�;�?�:.�.'� K`.'��"�.�_ �r,?�zaY'�e'�s�;.,�+�.., r:..a�_ ..i�.-_
z "
,<..,,....' . ..:.. . _ . �.,... ��,y- . ....vs. . ..,•,�i.. ...'�>S.',h-r _.. . �• . , ��' .�i�,,. � �.. .. ._ . . .......
For date.s of death on or af�er July 1,1994,and befo�Jan.1,1995,the tauc rate imposed on the net value of transfers to or tor the use of the surviving spouse
is 3 pe�nt(J2 P.S.§9116(a)(1.1)(�].
For dates of death on or aft�r J�. 1, 1995,the tax rafie imposed on the net value af trans�ers to or#or the use o�the surviving spouse is Q peroent
[72 P.S.§9116(a)(1.1)�ii)l.The stadrte c�Oes not exer�t a transfer to a�spouse from tax,and the statutay requirem�ts for disdasur�of assets and
fi�ng a tax retum ane st�l applic�le even if ihe swvivir�spouse is the only be.nefiaary.
For dates of death on or after July 1,20�:
• The tax rate imposed an the net value of trans�ers finm a de�ea�ed d�d 21 years of�e or yamger at death to a for the use of a natural parent,an
adoptiv8 panerit or a st�patBnt�the ct�ld is 0 perc�nt j72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net va�ue�trar�ers fio ar�ortl�e use�the de�ent's 6r�al benefic�aries is 4.5 p�ent,exc�ept as rw�sd�[72 P.S.§9116(a�1)j.
• Tt�tax rate irr�OSed on the net value of tramsfers to or�r the use of the decedent's siblirgs is 12 per�ent[72 P.S.§9116(a)(1.3)j.A sibling is defined,
under Sedion 9102,as an ind'nridual who has at least aie parent in c�ornmon wiri�the deoedent,whether by blood a adop�on.
. =
REV-s5o8 IX+(o8-s2) =
ennsylvania ����� E
p�r oF�v�r,c� CASH,BANK DEPOSITS&MISC.
1NH9tITMKE TAX RETURN pERSONAL PROPERTY
a�uerr oEa�r
ESTATE OF: FILE NUMBER:
��CSS/-e /�Y1. �"�d�e.
AN I�property�joi�oyrned'�tipl�t ot wnri�vorship m�#be disdo�ed on SdiedWe F.
� VAWE AT DAlF
NUMBER DESCRIP?!�1 OF DEATH
�. �'j/1 d G��'w ,�GG�• �D�I�6 I'I✓rZ ��Y�i�'Q I^ .i17 l]Q N i� I��J �/ ��
� v
arno,�� m�,��� � �-� .�-' �a �,�,,�%�,�.�k �3�,�oo,��
, � -��. ��. � ��sr �
��.(also er�ter on une 5,ttecapitulation) # ��q 0�.�
If more space is needed,use addftional sheets of paper of the same size.
RE�1511 EX+(08-13)
� pennsylvan�a SCH EDU LE H
°�"�n"�ro��vE"uE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE HUMBER
���s✓ � �, �a�t
Deceda�t's debts m�t be r+�portad oe Schcduk I.
ITEM
NUMBER DESCRIP'TION AMOUNT
A• � FUNERAL EXPENSES: /l. �p
1. � at�`NG�"" �r"i j.rer4.L. ►"1'a�� � ��o�,,0�9
�G� � �
i�. �i��^ �i2o�.v L.°a rr�� �•r•^y � �����
�^+1 ,
.. � . / �����
� ���15� r ��"' W�Q�rnDr'1 a.h �.s r'Y"'�< d
�
�c�t �',►vw^i t'-� �/Z•�"J
�, lcJo�pwg a N c� �d� �r-Y1r1i�r �
B. ADMINISTRATIVE COSTS:
1. Personai Representative Commissions:
Name(s)of Personal Representative(s)
St�eet Address
���Y State ZIP
Year(s)Commission Paid: �
2• Attomey Fees:
3• Family Exemption:(If decedent's address is not the same as ciaimant's,attach explanation.)
Claimant
Sheet Address
���Y State ZIP
Relatlonship of Claimant to Decedent
4• Probate Fees:
5• Accountant Fees:
b• Tax Return Preparer Fees:
7.
TOTA!(Also enter on Line 9,Recapitulation) �/�, ��c�_�
,REV-is�z Ex+�12-i2j
pe�nsylvania SCI�EDULE I
���''� DEBTS OF DECEDENT,
INHHtTrMKE TAX RETURN MORTGAGE LIABILtTIES�LIENS
RESIDENT bECEDEI�f
ESTATE OF FILE NUMBER
Repoit debt�incurrod by the daoeaent prior to de�th tlat ramaMed unpaid st the date ot desth,indwN�g unrei�nbuned medic�axpemes.
� � VALUE AT DATE
NUMBER DESCWpTION OF DEATH
1- L ss�e�c �ous.e �l�''.�aL �•�.�� I.Z a�-1. I I
�� 1-�m� S ;,;.� ,�.�os ��a� �,�o,s`�
-� � �
, ��� �3 f gS
�, 'Y'� �a.
,
�/� 1���Z..d� �'' °y
..-� � ,p ��' �D
J` , �.v/V�G�� 1'1't4�� �
TOTAL(Aiso enter on Une 10,Recapitu�a�on) ; I Ca.�'S��3�
If more space a needed,insert additia�ai sheets of the same�ize.
_ __ _ . - _ _- _ _
;OS REV(9/11)
�,,� ..
� J�� ',�"{_ �, �,
� �+ �t
a�
+�_
� t
� '
��
`�:
��
c_�
�`f�
� 0. t '�fi�
�� �
�
��
��
��5 �"
R-u�
�, ��� .
��S a
:�� f r,.
:.`,�+�� ` .,:
?„w 1; �.. ��„�
��,td�.x'-'��"�F,xt�...._,..'�""".
u�a ;;-
4.ry�:
.��.�as���.
�±+
_-:�..::.�.;--;:,_
.-w'�'
..-:,....;.�'"n
'-..�.;
=` :.
��;
_�'.
-TY.
:�''y
tl_�_
".��
1�.,..�',-�„''�"
-��'.�4i..v'lp�'
�
.'�'4j1.�:
cs•.
. s�
� c� '
�
�