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Home My WebLink About05-13-14 (2) .1 _ 1505610105 REV-1500 Ex(wzi)(R)l ^T PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual,Taxes County Code Year File Number PO Box 28o6oi INHERITANCE TAX RETURN Harrisburg,PA i7i2&o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05- J / ao(n os 31 /?S Decedent's Last Name Suffix Decedent's First Name MI /n 1JiuJus�rhPenne`f71 - - .. .. . _ (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 Return O 2.Supplemental Return C'= 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future interest Compromise(date of C) 5. Federal Estate Tax Return Required death after 12-12.82) O 6.Deoedem Died Testate 7.Decedent Maintained a Living Trust T 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C� 9.Litigation Proceeds Received C=) 10.Spousal Poverty Credit(Elate of Death C=i 11. Election to Tax under Sec.9113(A) Between 12-31.91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ✓✓ r REGISTIE,E�OF WILLS US"NLY -0 c M n r''3 C � First Line of Address //'''++ hh p �0 ,Jry`a l I�CJ� Co C Er L•YPe (< r I.- � � Second Line ofAdf�ss City or Post Office )J State 21P Code ILL `' c'' EC hQnrC'a6c+y5 �rn C=>( 70S (fi4 K i Corresponderrt's etnaN address: Under penalties of pequry I declare that I have examined this return,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, SIGNA .RE`OF nN aceonNSIBLE FOR FILING RETURN D9TE / s lfI!Y ADDRESS �� / /o 0 y �4�i�r. r`��<�.' F`=-�i G + � r..r I�o t`e� SIGNATURE OF ARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J V°/ 1505610205 REV-1500 EX(FI) Decedents Social Security Number Decedent's Name: K-enh e RECAPITULATION 1. Real Estate(Schedule A). ............................................ 2. Stocks and Bonds(Schedule B) .... ...... 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule Q ..... 3. 4. Mortgages and Notes Receivable(Schedule 0)... ........ ....... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E), 5. J-/ S-8 F/ 6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested 6. 7. Inter-Vms Transfers&Miscellaneous Non-Probate Prop" (Schedule 0) C= Separate Billing Requested........ T 8. Total Gross Assets(total Lines I through 7)..... ......-.............. 8. 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. >C 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)........ 10. 11, Total Deductions(total Lines 9 and 10)......... ....... ........... 11, q6-(_55 c5- 12. Net Value of Estate(Line 8 minus Line 11).... ........ ......... 12., 13. Charitable and Governmental SequesWSec 9113 Trusts firr which an election to tax has not been made(Schedule J) ........................ 11 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 0. TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under See.9116 (a)(1.2)X-0- 15, 16. Amount of Line 14 taxable at lineal rate X.0- 16, 17. Amount of Line 14 taxable at sibling 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 C=3 Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME// �en✓� C Th U r7 s fi ght STREETADDRESS loo�l r,# C✓er/ (j)� CrfY STATE ZIP Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) O. G G 2. Credits/Payments A.Prior Payments B.Discount 3. Interest Total Credits(A+B) (2) 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3) FIII in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) Q. G G Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER 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.......................................................................................... ❑ Ej b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ El c. retain a reversionary interest.............................................................................................................................. ❑ 0 d. receive the promise for fife of either payments,benefits or pre?...................................................................... ❑ Ej 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ El 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ B 4. Did decedent own an individual refirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the lax 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 imposed 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 lax,and the statutory requirements for disclosure of assets and filing a tax return are still 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 death 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)]. e The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1508 EX+(08-u) VIEWi pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE DE ED RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Karma /7u9Gr OCra- 01056 Incidde 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 1. /�e m e•r J3-t EON�Ouire �U V.. LJ(O (/f oe 6 � C hl G3 ��^� P 1705- - ��r-f is a5'v0E? C /G,e I O`� N of n3 6 �e�<h Cr, f I S $3.30 / 000 �c v /Je /"ti 170 I7J verI JPA � /Jucve✓ F.1 e✓A 1,71/0,00 „e 170?6 5G, /GAct eyy II iuG C TOTAL(Also enter on Line 5, Recapitulation) $ 3 1 F If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (08-13) mi pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE RETURN ADMINISTRATIVE COSTS RESIDENT TDECEDENT ENT ESTATE OF FILE NUMBER kenne �/ l / 0(,5 he 2c, 0109 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. tor 1. l-er,a �P v� nl '.' y04 . 00 ghJl o� 7CcH�l rts� Fo.le✓ 021 S'. yU Uax y4S e 74 -5-00..S0O. 00 Rers �� l"c- ( 76,31 / i G-1h4VlG IUle�ev)eI1 1Paorigl 6,-5,0, C, fPC hSh (l %�+"4 J"C IJO SO B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 1 �0 0, O 0 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: ('j (f S. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ z/S ES 6 S If more space is needed,use additional sheets of paper of the same size.