HomeMy WebLinkAbout09-08-14 i
f 1505610105
�•1 REV-1500 EXle$-,"IH
OFFICIAL USE ONLY
Department of Revenue pennsytvatlia
Bureau of Individual Taxes INHERITANCE TAX RETURN County Cods Year File Number
2
PD BOX rg PA 1 t�
Harrisburg,PA 17t2&0601 RESIDENT DECEDENT rf V -15 135-1
ENTER DECEDENT INFORMATION BELOW
X0/3 9-?.- iq 19
Decedent's Last Name Suffix Decedent's First Name MI
,COST ER r LIZ t�-? 3t� 'r{ Jr
(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 MUSS BE PILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
4W 1.Original Return Q 2.Supplemental Return C) 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate Cl 4a.Future Interest Compromise(date of C) 5. Federal Estate Tax Return Required
death after 12-12-82)
O 8,Decedent 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 Proceeds Received O 10.Spousal Poverty Credit(Date of Death C} 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 `
v eLyNj L. SrnALL w`aeD r7 / 7- 15�
c m
REGISTER�F3jLLS US£4RLY ��,
O7
First Line of Address m - e i tTt
9Z4 4A MIL iOn( «' o
Second Line of Address C, cry
C CJ
-v..� u m
City or Post Office State ZIP Code +1_DI P+LEO 4,CA R
Correspondent's e-mail address:
Under penalties of perjury,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.
SIBWf ERSON RE,SPONSIULE FOR FILING RETUR(J(,'[,.�. }� j/j� p �7 OAT
lcADDRESS.% [4'�C7Yl .3CiY�7/_—�C_,I,CA,tiny„11 t.7 JCl"�Vl/tA.^"''-e-t T'1� a /i t
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
�4
1505610205
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A).
2. Stocks and Bonds(Schedule 8) .......... 2,
3. Closely Held Corporation,Partnership or Sole-Proipfletarshlp(Schedule C) 3,
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash.Bank Deposits and Miscellaneous Personal Property(Schedule E)...-- 5.
6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested_ 7.
S. Total Gross Assets(total Lines 1 through 7). ............ 8.
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9.
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10,
11, Total Deductions(total Lines 9 and 10).......--..................... If.
12, Net Value of Estate(Line 8 minus Line 11).............................. 12,
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ...—................... 13,
14, Net Value Subject to Tax(Line 12 minus Line 13) ....... 14,
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(12)X,O— 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 is.
19. TAX DUE............... ........ ........ ...................— 19,
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=D
Side 2
1505610205 1505610205
REV4500 EX(Fi) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
L_I f-13 77 J, �6i
STREET ADDRESS
STA�n ZIPC O
Tax Payments and Credits: 7°
f. Tax Due(Page 2,tine 19) (i}
2. Credits/Payments
A.Prior Payments
&.Discount
Total Credits(A+B} (2)
3. Interest
j3) �
4. if tine 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT,
Fill 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)
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.......................................................................................... ❑
It. retain the right to designate who shall use the property transferred or its income_...................._.................... 0
o. retain a reversionary interest..._.........._........._......................__..................................._................................... 0
d. receive the promise for life of either payments,benefits or care?...................................................................... 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. 0
3. Did decedent own an in trust for"or payable-upon-cleath bank account or security at his or her death?.............. 0
4. Did decedent own an Individual retirement account,annuity or other non-probate property,which
containsa beneficiary designation? ...................................................................................................................... 0
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 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 imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
f72 P.S,§9116(a)(f.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,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)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in f72 P.S.
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 R&§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.