HomeMy WebLinkAbout05-21-15 J �g pennsylvenia 1505614105
{� s...M..ax.,,.. ex(a�-�a)(vu
REV-1500 OFFIGIAL USE ONLY
GounyCotle Year FYeNumber
Bureau of mGividual Taxes INHERITANCE TAl( RETURN C)
PO Box 28o60i RESIDENT DECEDENT �-� ��, �� n
Harnsburg, GA 1]128-0601
ENTER OECEOENT INFORMATION BELOW
Social Secunry Number Dale ol Dea�h MMODYYYY Oate of 8irt� MMo�VnY
/& a� - i�2 _��.c,� os - a9- i9�&
DecetlenPs Last Name Suffn DecedenCs First Name M�
PALM�R �R �!z�il✓.C� �
Q(Applicable�Enter Surviving Spouse's IMortnalion Below MI
Spouse's Las�Name Suffix Spouse's First Name
THIS RETURN MUST BE FILEU IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
p 1.Onginal ReWm S 2-Supdemental ReWm O 3. Pn�mao tl2138u2�m(date ot tleath
p 4.AgnculWre Exemption(date ot O 5'tleath alflerr124282j�omise(tlete of p fl Fetleral Es�ale Tax ReWm Required
tleath on or after 14-2412)
p 1.Decetlenl DieE Tes�a�e O 8� Decetlent Main�ainetl a Living Tmsf _ 9. To[al Number oi Safe Deposd Boxes
(AOach copy of will.) (Attach copy of imst)
p 10.Ldigation Proceeds Receivetl O >>.Noo-Probate Transieree ReWm O 12_ DetenallElec[ion of Spousal Trusts
(SCM1etlule F antl G Assets Only)
O 13.8usiness Pssets O id.Spouce is Sole Beneficiary
(No tmsl involvetl)
CORRESPoNDEN`- THIS SEtl10N MUST BE GOMPLEfE�.ALL CORRESPONDENCE IJID CONFlDENTLLL TR%INiOMMRTbX SHOUL�9E qRECTED TD:
Name �aytime Telephone Number
�nNi< T'I�nLMt2 �� •��� - 6 �S- uiiS
First Lipne oi M�tlr/ess
� Qc� yORK �O�7D— Ler �n
Sacontl Line�(Adtlress
City or Post OKw S�a�e ZIP Code
C7a✓e2 I�q /')3/S�
r p
CorteapondenPsemailaddreu: � P�� 1U� C �f�bG > �Al✓� � �
i
REGISTE� LLSI15[9JILY�7 n
CJ
- � �J
REGISTEROFWILLSOSEONLY -�� - '-�
DATE FlLEO MM�OYYYY . N r 1
r )
��l
�!
OATE FlLED STAMC�.. � ;q
�l �V1 n
U7 �
PLEASE USE ORIGINAL FORM ONLY
Sid¢ 1
� IIIIIIIIIIIIInIII���II��I�IIII�N�lllllllull IIII IIII , ���, , ,,, �� i �,
��
REV95W E% (FI) Pe9e3
File Numha�
DecedenYs Complete Address:
DECEDENT'SNAME �_, �—.
//tFlNK l ��le.mc-n 2 _ _ . . .—. . _. .—.__. . .. . ._.
sTaEErnooaess � � ��
BoZ � C/SLURN �I " L)O7 07 � � _. . __. ._.. .
CITY . __ �MP.. .- `L .—.. . . . . .. —. _ . . - . _. IiSTATE/� �IZIP/ �� IJ
Tax Payments and Creditx �i� /867 a�
1, Tax�ue(Page 2,Line 79)
2. CredilslPaymenis
A.Pnor Paymenis — —� �—
e.o�:�o��i __.. . __. /�6 7• aG
(See inslmctions.) To�al CrediLs(A i B j (2)
3. Interest (3) d
4. It Line 2 is greater Uan Line 1 t Line 3,enler Ne Ofierence. This is ihe OVERPAYMENL (a) Q
Fill in oval on Page 2,Line 20 to requesl a rePo�N.
5. Ii Line 1 4 Line 3 is g�eater�han Line 2.enle�t�e dilfe2nce.This is Ne 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 decedenl make a Uansfer and: Yes No
a. retain t�e use or incane of Ne proVertY�2referted.............................._._..........._........................__........... ❑ �
b. re�ain Ue dght fo designate who shall use ihe property Vansterted or its income _._........_.._.........._............ ❑ �
c. reGin a reversionary in�erest.._...._...._............__..........__......._._................__.........._.........._.............._._.... ❑ �
a. receive ihe Oromise for IHa of eiTher PaYments.benefi�s or nre?..............................._.................................._. ❑ �
2. If dea�h occurte0 after Dec.12, 1982,did Oecedent transfer D�Perty within one year M deatl�
withoN receiving aeequate consideration?......._................_........._............._..............._........................_._........... ❑ �
3. Did decedent own an'in W sl fof ar payable-upon-0eath bank accoun�or seanty at his or her tleath?............. ❑ �
4. Did decedent avn an individual retirement accounl,annuiry or o�her nortyrobate property,whiU
contains a benefivary designation? ...................................................................................................................... ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUES710NS IS YES,YOU MUST COMPLEfE SCNEDULE G AND FILE R AS PART OF THE RETURN.
For da�es of death on or aRer July 1,1994,and before Jan. 1,1995,�he tax rate imposed on ihe 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 dafes of tleaN on or after Jan. 1, 1995, me lax rdle imposed on tl�e net value of transfers W or for Ne use M the survivirg spouse is 0 percent
�/2 P.S.§9116(a)(1 1)(ii)J.The staWte dces nol exempl a hansfer to a surviving spouse 6om tax,and ihe shaWtory requiremertls for disdowre of asseLs and
filing a Ux relum are sUll appliqMe even if the surriving spouse is ihe only benefciary.
For dates of death on or after July 1,2000:
. The tax rate imposed on Ne rret value of Vansfers from a deceased child 21 years of age or younger at dealh to or for ihe use of a nalural parent, an
adoptive parent or a steo-parent of ine chiM is 0 percent[72 P.S.§911fi(a)�12)).
• The tax rate imposed on ihe net value of transfers to a fa ihe use of ihe decetlenfs lineal henefiaanes is 4.5 percent,ezcept u noted in�/2 P.S.§9116(a��i��.
• The�ax rate imposed on Ihe net value of transfers to a for!he use of the decedenfs siMings is 12 percent(72 P.S.§9116(a)(1.3�J.A siWing is defined,
under Section 9102, as an indivitlual who has at least one parent in common with the decedent,wheMer by blood or adop6on.
J Lsos6142os
REV-1500 EX(FI) Oecetlents Sociai Secuny Number
�as - �- 9�'34
oeceae�rs rveme
REGAPRULATON l�
1. RealEslale(SchetluleA) ...... -�� �--� ��- ����-" '-- �' v
. ... .... ... ... .... .
2. Slwks and BonGs(Schetlule B) . .. .... ..... . ... .... .. .... ... 2 0
3. Closely Held Corporafion,Partnership or Sole-Proprietorship(Schetlule C) ... .. 3. �q
4. Mortgages antl Notes Receivable(Sc�edule D)... .......... ....... .. 4. V
5. Gas�,6ank Depovts and Miscellaneous Personal Property(Schedule E).. ...-. 5. Q
6. Join�y Ownetl Propetly(Schetlule F) O Sepaa�e Billing ReQuested .. .... . 6. �
�. In�e�-Vivos Tronsfers 8 Miscellaneous Non-Probate Pioperty D
(Schetlule G) O Separzte Billing Requesletl....... . ].
0. Tofnl Caross Asceh(lotal Lines 1 Mrough])... .... .......
_ . . e yiV9 S�
9. Wneral Expenses antl Atlministra�ive Cosis(Sc�etlule H).. ... .... ... ... .... 9. Q
10. Debts of Deceden�,Mortga9e Liabilifies and Liens(Schedule I).. .... .. ....... 10. �
it. Tobl Deductlona Qo�al Lines 9 antl 10).. . ........ ... ...... .... 11. 4
12. Nel Value of Estate(Line 8 minus Line 11) . ..... ... . ... .... ... ...... 12. Q
13. Ghantable antl Govemmental Bequests/Sec.9113 Tmsts for which
an eleclion to tu has not been matle(Sc�edule J) .... ....... ... ......... 13. �
14. NatValueSubjecitoTax(Linel2minusLinel3) . . --.. ������ � -� ���-��� �- �a' �
TA%CALCULATON-SEE INSTRUGT10N5 FOR APPLICABLE RATES
15. Amount ot Line 14�asa�le
a�Me spousal�ax rd�e,or
transfereurber5ec.911fi 15 �
(a)(12)X.0_
16. Amount of Line 14lapable 16. Q
at lineal rate X A ��'.Y
1]. AmounlofLinel4�axable �� O
at sibling mte X.12
18. Amount of Line 14 tauble 18 O
atcollatealre[e X.75
19. TAXDUE . . ....... .. ....... ... ........ . 19. O
. . ....... ... . .. . ... ........
20. FILL IN THE OVAL IF VOU ARE REpUES11NG A REFUND OF AN OVERPAVMENT �
UMer penahles of perjury.I9etlare ve eumiretl Ilils reWm.induCln9�^Pa^M^9 sMetlules aM sta�emeMs.aM b��e best N mY krroM N9e antl�ellef,
it Is true.mre t antl plete. Decla lion M pepa M1ar Man Me permn respaside(or fi4�g ine relum is LasaJ on all irifamation W wnidi qaparer M1as
anY Mmwled8c. �A E
SIGNFTUREOF SON ONSIBLE ILI RETORN S - S^
�_
AD ESS �j
Ou 02/C ^ �GT . O �.�/ 0✓6 1J �
SIGNATURE OF PRE AREROTHERTNAN PERSON RESPONSIBLE FOR FILING THE RETURN �ATE
A�ORESS
IIIIII�III�I�OII��"L�W'F���NS��,IIIIIIY�I�III��� Side 2
I icn<<.iu�n[ �
L
�
��
� '
�
�
� �
\ fd
� � �
�0 3� �'
T p o
� � � �'
�
�
^ .� �I C c ` r� n'
V -- � � :� �
� y R� � � �� � i� � �`�i
� �
r \y� � c _
(l C�. `� _ y � ��
' � �. \C ' �� -. c�
�, � �_. m
�� r� � �- �> �
� �
�` c
� c v ti
� �
� ��
w � ��Im U
�
�,
€;EH "
�;C7 -
-J
:5�� �