HomeMy WebLinkAbout11-624 1505614201
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Y
RECAPITULATION
1. Real Estate(Schedule A). ... . .... ..... ...... .... ... .. ... .. ... .. .. ... . 1.
2. Stocks and Bonds(Schedule B)✓. ........ ..... ......... ...... ... .. ... . .. 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship(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) O Separate Billing Requested . . ..... 6. .0 o
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate'Property `
(Schedule G) O Separate Billing Requested... ..... 7.
8. Total Gross Assets(total Lines 1 through 7).. .. .... . ....... .. ..... ... .. . 8. 616 910. 0
9. Funeral Expenses and Administrative Costs(Schedule H).. .. ... .. .... . .. .. . 9. a 0 3 •LTJ -
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)... .. ..... .. .. . 10. 0. t
11. Total Deductions(total Lines§:and 10):'.:.'..... .... ... .. ... .. .... ... .. . 11. .m . 0
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. -
3r:
14. Net Value Subject to Tax Line 12 minus Line 13
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the•spousal tax rate,or
.r transfers under Sec.9116
(a)(1.2)X:0_ 15.
16. Amount of Line 14 ctaxable
at lineal rate 16. 1 `( . d
17. Amount"of line 14 taiable
at sibling rate X.12 17. . s
18., Amount of Line 14.taxable
at collateral rate X.15r • 18. J •
19. TAX DUE . . .. .. .. .... .. ..... .... 19. �• '0 D
1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. O
q
Under penalties of pedury,I declare l 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 person responsible for filing the return is based on all information of which preparer has
any knowledge. r
SIGNATUR PEWQN.RES SIB R FILING RETURN }SATE
DD SS
AGN • /.e r t �/1 y en S �' l-73 2
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
ilii Side 2
1 6142 1 1505614201 J