HomeMy WebLinkAbout04-22-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
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FILE NUMBER
6l..L-O~
COUNTYCOOE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
001-<11-
NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
f'1/kuL J/lJl(oL 1) E.
DATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM-DD-YEAR)
;2- - 0:'- I). -~V- 35
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
It'j' - .;c,
02(,((:)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died T~state (p.,\tactlcopyolWill)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ofdealh atter 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1-95]
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} (MtachSth0)
FIRM NAME (II Applicabie)
COMPLETE MAILING ADDRESS
If K,'w~ $.
E. .5-h~~, PA. (No(
TELEPHONE NUMBER ,r
oJ 76
t'J.I-J~-33
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole.Proprietorship
)
4. Mortgages & Notes Receivable (Schedule 0)
~07?'.Ig-
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines1-7)
(6)
(7)
(8)
--.,J
S' 0 7?', I,f'
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(9)
(10)
(11)
(12)
(13)
~ 078', IS--
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable al the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17) 76 if, 3;- - ..;-z ~ 9;Z0, 9/
,
x .15 (18)
(19) # 7'dO' ?/
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
f( 07 f', If-'
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. I1l
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
--
Decedent's Complete Address:
STREET ADDRESS :;;
-
CITY
zr ',;.S7- '1'0 I
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A+ B + C)
(2)
3. InteresVPenalty If applicable
D. Interesl
E. Penally
TotallnteresUPenally ( D + E ) (3)
4. If Line 21s greater Ihan Line 1 + Line 3, enler the difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 31s greater than Line 2, enter the difference. This is Ihe TAX DUE, (5)
A. Enler the inlerest on Ihe lax due.
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
o ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .................................
b. retain the right to designate who shall 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 December 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 account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .
Yes
.0
o
o
o
....0
...0
No
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to !he best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal represenlative is based on all inlormation of which preparer has any knowledge.
F PERSON RESPONSIBLE FOR FILING RETURN
Q.. ~...k. ~)
DATE
- 3 - 0.5-
ADDRESS
i 1G'~Sr. ~ S;~. ~,W$O{
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE '
DATE
ADDRESS
~1L_W . r In III _
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS. &9116 (aJ (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. &9116 (a) (1.1) (ii)].
The statute does not exemot 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent oflhe child is 0% [72 P.S. &9116(a)(1.2)].
The tax rale Imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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 Ihe decedent's siblings is 12% [72 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.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlDEN1 DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF
c
fl///(u L;9
/(11/(oLD
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
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