HomeMy WebLinkAbout06-19-15 i
J 1505.611101
REV-1500 Ex toZ_,,,
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
YEMRTMENI OFF NUE County Code Year File Number
Bureau 2IndividualTaxes INHERITANCE TAX RETURN
PO BOX rg,PA F I FE
�� �1Harrisburg,PA 1yi28-o601 RESIDENT DECEDENT 2 �+
ENTER DECEDENT INFORMATIONBELOW
Social Security Number Date of Death n�MM{{DDD�DYYYY Date of Birth MMDDYYYY I
Decedent's Last Name Suffix Decedent's First Name MI
J� �CeJOILIUDI��lC�C7�
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
�aaacaoa��uaa asg , 13
Spouse's Social Security Number
THIS RETURN MUST BE.FILED IN DUPLICATE WITH.THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return p 2.Supplemental Return O 3..Remainder Return(Date of Death
Prior to 12-13-82) .
C=D 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
Y t death after 12-12-82)
O -6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
1. . (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
REGI E DF WILLSLISE OW O
` 1 n
First Line of Address M C.0 1-1 rr1
Second Line of Address C
DATE FIL 07 O
City or Post Office State ZIP Code
���► � UP 1 0 1 1
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.
SIGNATURE O"F P5RSOV RESPONSIBLEAR FILING QATE
ADDRESS °
t0 i �,Au n A PVKA Oct 1
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611101 1505611101
I
1505611201
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
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 (6 O• , G
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .... .. 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.... . ... 7.
8. Total Gross Assets(total Lines 1 through 7). .. . . . .... . ... . ... .. . .... . ... 8.
9. Funeral Expenses and Administrative Costs(Schedule H). .. . . ... .. . .... .. .. 9. 2 1 5
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18. •
19. TAX DUE . .. . .. . . .. . . ... ... . ... .. .. .. . . .. ... .. .. . . . . . .. .. . . . .... .. 19. •
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505611201 1505611201 J
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. 1 FUNERAL EXPENSES: 2 t 0 33_W5
q
[ Y-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:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ �-{ es—
If
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
64
68 3j,
-3° bN k V�o vv\c l , zap m - 0 0
TOTAL(Also enter on Line 10, Recapitulation) $ '7 7 (� 2-2-
If more space is needed,insert additional sheets of the same size.
z
REV-1500 Ek Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
STREET ADDRESS
Mess ta�I j.tFew g:As ki Me-5sra-h ✓ill0.4e
!0 6len Dri i e_ - �oorn 51 �
CITY STATE ZIP
tiler-h"c CS b u_rg A l D55"
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)
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)
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.......................................................................................... ❑ r[✓�1�+
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ u
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?.............................................................................................................. ❑ r�
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ ISI
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.§911 6(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.
June 17, 2015
Lisa M. Grayson, Esq.
Register of Wills& Clerk of OrphansCourt
Courthouse
1 Courthouse.Square A�f - __. ! ...
p
Suite 102 !�
Carlisle, PA 17013 iT) �
RE: Lucille A. Slade, Deceased
Dear Madam:
Please find enclosed an original and copy of the fz
for the decedent, Lucille A. Slade, nal Pennsylvania inheritance tax retain
Trusting this is satisfactory, I remain
Very truly yours
James W. Bruce, Esq.
10 Redwood Place
Camp Hill, PA 17011
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