HomeMy WebLinkAbout05-20-15 (2) J Lsos61o1o1
REV-1500 E"`°,,°, � OFFlCIFLUSEONLY
PA Department af Revenue Pe��sylvanla Caunly Cotle Vear File Number
Bureau oflntlivitlualTaxes ����" - INHERITANCE TAX RETURN
POBOXi8o6o� RE5IOENTDECEDENT
H ri b g PA 1y 8 O6
ENTER OECEDENT INFORMATION BELOW
Social5ecunty Numbe� Da�e of Dea�h WMO�VYYY Date of Birth MMDDYYYY
�.� . � � � �
Suffx Decetlent's First Name MI
�ecetlenPs Last Name � � �
r �
(If Applicable)Enter Surviving Spouse's Intorma[ion Below MI
Spouse's Lasl Name Su((x Spouse's First Name ❑
�
Spouse's Sociai Securiry Number 7HIS RETURN MUST BE FILED IN DUPLICATE WRH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BEIOW 3. Remaintler ReWm(tlate oi tleath
� 1. Original ReNm O ��Supplemenlal ReWm O ,o Z �BZ)
prior
p 4.Limitetl Eslate O 4a FUNre Interes\Compmmise(tlale of O 6 Fetleral Es[a�e Tax ReNm Requiretl
aeath a%er 1242-82)
p 6.Decedent Dletl Testate O ]. �ecetlent Maintaine0 a Living Tmst � 8. Total Number of Safe�e0osit Boxes
(Atlech Copy of Will) (A�tach Copy o(TmsQ
p 9. Lltlqatlon Pmceetls Recalved O ��� behveen1231 B1 antl qtl'les'f tlea�h O ��� �Attach SohaO'n0er Seo-8113(A)
CORRESPON�ENT- TMISSECTIONMUSTBECOMVLETED.ALLCORRESPON�ENCEANDGONFIDENTIALT�DaytRmeTeephoneN mbeELTE0T0:
Name
REG19[R OF WI 1152AH1'.b
� �]
_�
N -�
.. . _: �' � O ; 'J
First line of atldress �
,�
7 ,�
. _., , . 3 ..: _—'
Secontl line of adtlress � ' ��
w r' m
�o n
DATE F
Clry or Posl Offce Slate ZIP Code Y�
��.:���.��� .� ."�� �v�.� �� �
Lartespontlent's e-mail adtlress:
Untler penalties o�pe�lury,I declare��a�I M1ave examinetl IM1is re�wR inclutlin9 accompanying sc�edules antl slalemenLs,antl�o�M1e�es�of my knowletlge antl Oelie(.
u��s�ma,co rea em comv�e�e-oeaereuo�or preparer omerma��ne ve5onai represemeuve�s oasea on au���rormeron orwmm�Prepare�nes a�y knowieeqe-
' onrE
SIGNPTtIRE OF PERSON RESP�SIBLE FOR RLING RETURN �I �� I I �
\l� 1 rY(!f4 � r( i..lX �—
noo�s . �_� � ��^-j - �_ 1
� on
SIGiATUREO'P�PAR��OTHERTHANR(EPRES�TATC�� ^ �
/l � % 1 Y(r) ��J , J
A�DRE55 ��
PLEASE USE ORIGINAL FORM ONLV
Side 1
L 1505610101 1505610101 J �
1
J Lsos61o1as
REV4500EX
Oecetlen['s Social Searity Number
oecedanrs Name�. �
RECAPITULATION
1. Real Esla�e(Schetlule A). . . ... . .. . ... ... . .. . ... . .. . . ... ... . .. . .. L .. oy.
2. Stocks and Bontls(Sc�etlule 8) .. . ... . .. . . . . . . ... . .. . .. . .. . . p O y .
3. Closely Heltl Corporation,Partners�ip or Sole-Pmprie�orship(SchedNe C) .. . 3 . ��
.. ��yd•'i�.
4. Mortgages and Noles Receivable(Schetlule 0� . . . . . .. . . . .. . . . . ... Q . � '
.:i.� O�;u�- .
5. Cas�, Bank Deposits and Miscellaneous Personal Propetly(Schetlule E)... . .. $ � g ��y�o�^
tl
6. Join�ly Ownetl Property(Schetlule F) p Separa�e Bllling Requestetl .. . . 6 � (�c -
]. In�er-Vivos Transfers 8 Miscellaneous Non-Proba�e Propetly � , ._ `�„�y�,y�,�,�..
(Schetlule G) O Separete Billine ReQuestetl_ . ... ] � -
- � � �� a-::�.
B. Total Gross Asse�s(tolal Lines 1 through 1J __ „ 8 . � "��
9. Funeral Expenses antl Atlminisha�ive Costs(Schedule H).. . . _ . , _, g � n�y,
��vra
� �. � r, � ct ?D.:_
10. Debts of Decetlent, Mortgaqe Liabililies, and Liens(Schetlule I) . .. . ip /�Y '
� :n -.. k �3�tlai.r
11. Total Detluc[ions(to[alLines 9 and 10�... . . . . „ , �� '
. a p�F
. �y ,r:
12. Ne[Valve of Estate(Line 8 minus Line it) . . �p � � C
13. CM1atlte�le antl Govemmen�el Beques�s/Sec 9113 Trus[s for which � �f� �n, � "'�
y.,.:
an election�o tax bas not been matle(Schetlule J) . .. ... . .. . ... . .. . . 13 .
. . . :� � ��^ .y.:....
14. Net Value Subject ta Tax(Line 12 minus Line 13) . .. . . . . .. . ... 14 � `1 q � G ,�� �
TAX CAICULATION SEE INSTRUCTIONS FOR APPLICABLE RATES �X � lJ
15. Amoun�o(Line 141axable
atihe spousal�ax ate,or
[ransfers under Sec.9116 �
(a)(L2)X_0— . . ��.� { " 15 , �� ;
i6. A ounlof Line 14��y ble - - .� - J ' ' �
atlinealrate X .p�`J' �']J� �9 ' 16 ;� - 5p`Q
R
1I. Amounto�LJnel4taxable . �S�'"�u 4�q :,mg-_ „�.� " {�
a�sibling ra[e %.12 " 1� � : :. �
'
18. Amount of Lme 14�axable � �� 1' '�' z"'�� �c � ' °
; � � � f
a[collateral ra�e X 15 � :.� Y �.
t
, t� 18 � y
19. TAXDUE . . . . __ . _ . .. . 19 � •: � �.�J,� ,�
20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUNO OF AN OVERPAVMENT
O
Side 2
L 1505610105 1505610105 J
eev-iso&Ex+(ve-io)
�� pennsylvania SCNEDULE E
oE��A,MF�„��AE�=N�E ' CASH, BANK DEPOSITS & MISC.
mi�exi*arv�er�ixxe�uarv ' PERSONAL PROPERTY
vesm=rv.oe�eoervr
EST'A�TE"OF: �1 FILE NUMBER:
V12�,61 ���1�r� �c� P -h ��� � ���CJ
NCWde the oceeas af litigation and[he tlate Ihe proceeds were rereived by[he estate.
All property jointly ownetl with right of survivorship must be disclaSeE on Schedule F.
IIEh1 VALUE AT DATE
NOMBER �ESCRIPTION Of DEATH
.. Checv� - Qoyvn�n�' Scc-am 'inburcnc� ��c a �a�cJ"� ,��
���S6Y1Q� �OQY1 .
�� � �«� ,�Gs ��Pos,a-�� on m4 3 � �0�3
N� , � t�`1 -�3 wos «�u�,�� ��� �
O�;E��ymC->yt�
TOTAL(Also enter on Llne 5, Recapitulatlon) $ a\ C
[f more space is needed, use adtlitional sheets of paper of[he same size.
' Paqe i File Number
anYs Complete Address:
N1'S NA�M�E.� ` r�y� �ry I {—�
_ ck,4x�. � _U-���iR r\ \)� _. . ._ _ _.._
�rtEETADDRE55 r1
5 �� ��� _ - -
_ _
cin -- ._— .. . _ -- � si �-��na
Tax Payments and Credits:
1. TaxDue�Pa9e2,L1ne78) (�) �� ��
2. CreditUPaymenis
A.PnorPaymenls __ -. -- - -
B.�iscount
� � TotalCredis(A+B) (2)
3. Interest
(3)
4. If line 2 is grea�er�han Line 1 +Line 3,enter�he diRerence. This is�he OVERPAYMENT.
Fill in oval on Page 1,Line 70 to request a refund. �4)
5. I�Line 1 +Line 3 Is greater than One 2,enter Ihe diRerence.This Is ihe TAX DIIE. (6)
Make check payable to: REGISTER OF WILLS, AGENT.
>�`a'�<rC.?�£'�s�'.�r.,:;&i`:�.'�� . . __ .�7 ���.���.mc--�'��`�`.!�;a�:"S��'t�.�. ... .. :�
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
7. Diddecedentmakeatransferand'. Yes No
a. retain the use or income of ihe pmperty transferretl _........._ _.__. ........_._ ............ � �
b. relain Ihe right�o designate w�o shall use ihe property Iransfened or ils income,. ..........- ����� ❑ �
c. retain a reversionary interest or _......_. ............ -... ..- -�- � �
d. receive�he promise for lde of either paymenis,beneFlls or care'+ _._ _._ ........ � �
2. If death occurred after�ec.12, 19ffi,eltl decedent Iransfer properry within one year of death ❑ �
wilhcutreceivingadequaleconsideration?..._ _......... __... ........_.. .. rtn
3. Diddecedentownan'inUus�for"orpayable-upon-0eathbankaccoun�orseantyathisorherdeath? ..... ❑ Y�
4. Did decedent own an inaiviaual retiremen�accoun�,annuity or other non-proba�e pmDeny,which ❑ �
con�ainsabenefciarydesignahon� ........._._ _........._. _......... .,_...... ...._._
IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
. � � .,� � � - _ � _ . � . � � . . .
For tlates o(death on or aRer July 1, 1994,and before Jan. 1, 1995,the tax rete imposetl on�he net value of iransfers to or for�he use of the surviving sp0use is
3 percent�72 P.S.§9116(a)(1.1)(I)].
For dales of death on or afler Jan. 1, 1995, ihe �ax rete imposed on the net value of transfers �o or for the use of Me surviving spouse is 0 percent
�72 PS. §9116 (a) (1.1)(ii)].The s�atute does not exempt a lransfer to a surviving spouse fmm tax,and ihe stffiutory requirements tor disGosure of asseLs and
filing a taz relum are still applicable even if the surviving spouse is me only benefciary.
For dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased chiltl 21 years ot age or younger at death to or fir the use of a natural parenL an
adoptive parent or a stepparent of ihe child is 0 percent[/2 P.S.§9116(a)�12�j.
. The taz rate imposed on �he net value of hansfers �o or for Ue use ot ihe decedenYs lineal beneficianes is 4.5 percent, except as noted in
�z vs.§sns(�.z)pz Ps.§sns(a)1�)1.
. The tax rate imposetl on Ihe net value of lmrefers lo or for ihe use of the decedenCs siblings is 12 percent[/2 P.S.§911fi�a�(1.3)J.A sibling is defned, under
Sedion 9102,as an individual who has at least one parent in common with the decedent,whether by 61ood or adoption.