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HomeMy WebLinkAbout02-04-15 1505611101 REV-1500 EX(02-11) 110 11 enns lvania OFFICIAL USE ONLY PA Department of Revenue p Y County Code Year File Number Bureau of Individual Taxes NUE DEPARTMENT UT REVE PO BOX 28o6oi INHERITANCE TAX RETURN Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT �' � 13 t ( q4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Aea 05 eta B ? 61ao ) 3 09 ) 1 q ) I Decedent's Last Name Suffix Decedent's First Name MI lfaAC 6C_ Yn (If Applicable)Enter Surviving Spouse's Information Below Spous 's Last Name Suffix Spouse's First Name MI Sp se's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Ifs 1.Original Return Q 2.Supplemental Return p 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) O 6. 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 O 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 Tj RE6197rEf3 OF WILQISE t�til�Ll f T1 f 71 First Line of Address C Second Line of Address ►-� C7 IT) S Cn C�i -ry City or Post Office State ZIP Code DATE FILA 5hiPPen56ul- 9 P0- » ash 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. SI ATURE OF PER(�,/7 N R NSIBLE RFI N ETURN DATE !{ "Mol� Sholuwbutqf012dS2 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 . 1505611101 1 1505611201 •'REV-1500 EX +'• Decedent's Social Security Number - Decedent's Name: RECAPITULATION E . +T. t+ +, ..!,• 4• 1. Real Estate(Schedule A). ... . ..... . .. ... ... . . . .. ... ... . .. ..... . .. 1. �}no (7,iVi ro_J Lo •C'�' 2. Stocks and Bonds(Schedule B) ... . . ... . ... ... ... ... ..... . ... .. . ..... . 2. OHO 1UJO�Q lolrovW 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 3. C✓JC�C��'LQLv����I�JC�•L�J�r 4. Mortgages and Notes Receivable(Schedule D)... . .... .. ..... . .. .. . .. .. . . 4. a� FO-1'I Q ���� "1Y, 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. ... 5. ❑ocuo 6nm 6. Jointly Owned Property(Schedule F)^ O Separate Billing Requested .. .. ... 6. JQ,ro Q ,Q •��� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property n (Schedule G) O Separate Billing Requested.. .. ... . 7. 1�71Q ���lQ�n.RED 8. Total Gross Assets(total Lines 1 through 7). ... . .. .... ..... . ... .. ... . . . . 8. ❑� � ,� IQJ�n.L IJl/� 9. Funeral Expenses and Administrative Costs(Schedule H). ... .. ... . . ... .. ... 9. vJ61©r u�O'Po(�VQ��- QJ 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). . . .. .. ... .. . . . 10. L0 i�0'QJlpo" ��Q�`Q�Q-2.Q 11. Total Deductions(total Lines 9 and 10). ... .. . . .. . .. . ..... ... .. ..... . ... 11. © Q Q'Q -�-�.r� 12. Net Value of Estate(Line 8 minus Line 11) . . .. .... ... . ... .. . .. .. . .. .. . ... 12. EUMD�_,& R 3�-111M 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 07 10 �I�����1 2, an election to tax has not been made(Schedule J) . . . . . ... .. ... .. . .... . ... 13. . 10 l(,lO E DO 0 of-1019 14. Net Value Subject to Tax(Line 12 minus Line 13) .... ..I. . . ... . . .... . . ... 14. a W b 3 • TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_ a �.� 15. C�DIa ❑�'❑� 16. Amount rate Line 14 taxable 0-'i��� [14I y1 �❑r--t�--�1-tm{-tl1111, . GlIl at lineal rate X.0 Il-f1�-alp-.lN�fll� •l/A/J 16. IL-.4Y�-1Nu11�-411��J�,J�r f. - 17. Amount of Line 14 taxable F-r-I [r ❑❑(-y"-►�►�(��� {���� -�t. at sibling rate X.12 - 17. il-tA�ll`--nR--4.A�-�( •uU ` 18. Amount of Line 14 taxable CC�� at collateral rate X.15 �•00 18t.+❑LJ c.. ` - 19. TAX DUE .. .. .. .. .. .... . ... . . ...... . ... .. . ... .. . ..... . ... .. ... .. . . 19. D❑ •❑❑ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT, y •; ,'� O Side 2 1505611201 1505611201 J REV-1508 EX+(ii-io) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: Or 11 a. MCA Y)CO (21-)(—" FILE NUMBER: Include the pr(Yeeds 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 RccrL�u n+ ��� 17ce Xe��- a�-tiv-- nui)s402 home-, to r�(oU3, I q �JC'. i,V�Qo( �{ Q'P/)SOnCc� l�►'n-S �,S >7�2d�- y4'S lc�2S JJ C' ,rl li n�,e u?1 �h uta✓� Cl�arU�l j t r\ A-,n,n a 4an w ck s s ^rte ee p,�en4- v� riLe b��� upon h4'' clQo` . TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. i :.. .. ...... .. ".. .. � � .. ..,J loot 0 T Gr F 1 f' }}t;pjynQ,. L1 REV-1500 EX Page 3 Fite Number Decedent's Complete Address: DEC ENT'S NAME STIIEftADDRESS /D CITY e^� �M STATE ZIP t 7 J G?l Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) � / 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) Q Q 3. Interest ? �/ 4. if Line 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................................................................................._...... ❑ 10 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 19 c. retain a reversionary interest.................................__....._.............................._................................................ ❑ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 2. If death occurred after Dec.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? .................................................................................................................... ❑ [ . 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 [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 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 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[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. . . .I n �� � . , - ,. �'.� . . ,� A . � .. �ti ` � � ! F } ' � - � � � � .. , -- � - --'T—�+wr„^ -�-.�...a _ .sem+r... ^e ti+�.r-.�......--.-�- � � .. - .. l i � �'