HomeMy WebLinkAbout05-18-15 (2) pennsytvania 1505614105
DEPAMMMMVE'UE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
INHERITANCE TAX RETURN 1 �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
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Decedent's Last Name Suffix Decedent's First Name MI
C. 1.El .To YcE
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(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
,44
' Ll
-.............__.........................__..........._.._... .................................... ..._.
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
4M 1. Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of 0 5.Future Interest Compromise(date of O 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82) �l
O 7. Decedent Died Testate O 8.Decedent Maintained a Living Trust L 9: Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
C=) 10. Litigation Proceeds Received p 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NameDaytime Telephone Number
First Line of Address _
5'0 7 f�u,�e HA,sE L�ivE' .�Zp.
Second Line of Address
I......._.._..........._..........................._..._......................................_...........-..._............_.........................................._......................._.._............_._............._..........._.._..._.__._........._............._............._..;
..........................._..__......._............._.._..........._......._..._............_.............._........_............................_................._.........._.................._..._.._..............._....._..__....................._._._....
...__...........
City or Post Office State ZIP Code
i
�antl�toDv/ �°� IS 7- 9
Correspondent's email address:. rn,
REGISTER:PF WILLS ME ONLY C�
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REGISTER OF WILLS USE ONLY i"'
�,'�AT" Et;ECl�VI�►C3,,> . .,-, f^"1
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DATE F14ED STA i "
ti
1505614205
REV-1500 EX(FI) Decedent's Social Security Number
.................
Decedent's Name: _T0YCC- rL4�
RECAPITULATION
1. Real Estate(Schedule A). ................................ ............ I
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. 00
6. Jointly Owned Property(Schedule F) CM Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines I through 7)............................. 8.
9. Funeral Expenses and Administrative Costs(Schedule H)............ ..... 9. 1
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.
11. Total Deductions(total Lines 9 and 10)................................. 11.
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.
14. Net Value Subject to Tax(Line 12 minus Line 13) .................... .... 14.
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 V 15. :
16. Amount of Line 14 taxable
at lineal rate X.0 16.
17. Amount of Line 14 taxable
at sibling rate X.12 Q Q 17.1
18. Amount of Line 14 taxable i i
at collateral rate X.15 s d J:2: 18.1
L
Ir
19. TAX DUE ............... ... ...................................... . 19.1
20. FILL IN THE dVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=:)
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge,
SIGNATURE OF P�2!N RESPO SIBLE FO ILING RETURN E Z01
ADDRESS
Pwrebage Z,;Ie tit/., Commodore,
SIGNATURE OF PREPARER ER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
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ADDRESS 6 A/-
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Side 2
It 11 IL 1505614205
t s
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
10YCC � , F11.tok
STREET ADDRESS
CITY STATE72i�7/
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) }9 9 6
2. Credits/Payments 00,
A.Prior Payments 7 T 9 7Q
B.Discount �/�; ��' Pe
(See instructions.) Total Credits(A+B) (2) `7 9. 6X
3. Interest
(3)
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) C
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.......................................................................................... ❑
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑
c. retain a reversionary interest .............................................................................................................................. ❑
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ IM
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.
y"
I%.A�3 ,
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)], j
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 step-parent 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.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF r. FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER L THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1• /V!u✓Orl4� ZrfG ISf�lranct (�olh"W'"M �A/ltll�
(!
a# &v, 7
Shares Ar ;
/ylo/�o J: re,113r7S d/), Wa UfA&r
l7aila T. 62nros, C&&fA r-
/1-yw" fi%/er s4v-soa
"antes F.//er, S/Gj�.sos�
l!r¢ ��a/ a�•D-a: /�u�ye e f �/s aaau/�� was
/Sa, 575-,
�GrG� rBG%7iC/It' rece llec/ �<z;. uc, // �o7a7, ,�.�0.// lDO�a — O
CA re ci;i'enf' %� r-;oo�f%ny �i/?lAe r Shure
TOTAL(Also enter on Line 7, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+.(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL
LL-EpXAPENSES AND .
INHERITANCE TAX RETURN ADMINISTRATIVE RATIVE COS 1TS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
F1-LER, JOYCE A: --
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: !e ZW 47rtal esfate-
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant Alel //CahlG
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. _ Accountant Fees:
6. Tax Return Preparer Fees:
7. Wn Fee fn Re4iAer of 4vills
0
TOTAL(Also enter on Line 9, Recapitulation) $ 16,0
If more space is needed,use additional sheets of paper of the same size.