HomeMy WebLinkAbout05-06-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
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Smith Ma E,
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE QNL Y
FILE NUMBER
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COUNTYCO[JE YEAR NUMBER
socrAl SECURITY NUMBER
207-07-7404
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return {date 01 death priorto 12-13-82}
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec, 9113(A) (Attach Sch 0)
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12/23/2004 03/14/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
PA 17110
0.00
0.00 i
0.00
0.00
52,415.91
OFFICIAL USE ONLY
N/A
[Xl 1. Original Return
D 4. Limited Estate
06. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date Of death after 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12.31.91 arn:l1-1-9S)
3,001.271
0.001__
(8)
55,417,18
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NAME
Har M. Baturin Es uire
FIRM NAME (If Applicable)
BATURIN & BATURIN
TELEPHONE NUMBER
717-234-2427
COMPLETE MAILING ADDRESS
2604 North Second Street
Harrisbur
12,777.00
1 ,227.97
(11)
(12)
(13)
14,004.97
41,412.21
0.00
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage L1abilifies, & Liens (Schedule I)
11. Total Deductions (total Lines g & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(14)
41,412.21
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under So<:. 9116 (a)(1.2)
41,412.21 X .045 (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
1.863.55
1 ,863.55
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16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Dece ent's omplete A ress:
STREET ADDRESS 335 Weslev Drive, AD!. 505 ,
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
1,863.55
0.00
0.00
000
Total Credits (A + 8 + C)
(2)
0.00
3.
InteresVPenalty If applicable
D.lnterest
E. Penalty
T otallnteresVPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request s relund
0.00
0.00
(3)
0.00
4.
to: REGISTER OF
(4)
(5)
(5A)
(58)
AGENT
0.00
1,863.55
0.00
1,863.55
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make
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 translerred; ........................................................................... D IZJ
b. retain the right to designate who shall use the property transferred or its income; ........................................ D IZJ
c. retain a reversionary interest; or ............................................."....................................................... 0 lXl
d. receive the promise lor life 01 either payments, benefits or care? ............................................................. D IZJ
2. II death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D IZJ
3. Did decedent own an 'in trust fo~ or payable upon death bank account or security at his or her death? ................. D IZJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D IZJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
PA 17112
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 3%
[72 PS ~9116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot 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 twenty-one 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% [72 P.S. ~9116(a)(1.211.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(111.
The tax rate imposed on the net value oftranslers to or for the use of the decedent's siblings is 12% 172 P.S. ~9116(a)(1.311. 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-1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Smith Marv E.
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real Drooertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1503 EX + (6*98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Smith Marv E.
FILE NUMBER
All property jointly*owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
-
REV-1504 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE.PROPRIETORSHIP
ESTATE OF
Smith Marv E.
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
soJe~proprietorshjp. See instructions for the supporting information to be submitted for sole-proprietorships.
FILE NUMBER
ITEM
NUMBER
1.
OESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV.1505 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSEL Y.HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Smith Marv E.
FilE NUMBER
1. Name of Corporation
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
ProducVService
4.
Common
Preferred
$
$
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . .
If yes, Position
. . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No
Annual Salary $
Time Devoted to Business
6
. . . 0 Yes 0 No
Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
7. Wastherelifeinsurancepayabletothecorporationuponthedeathofthedecedent? .......... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
DYes 0 No If yes. 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Mach a separate sheet for additional transfers and/or sales.
9. Was there a writlen shareholder's agreement in effect at the time oft he decedent's death? ............0 Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent'sstock sold? .................................................0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? .................... 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies offinancial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. list of officers, their salaries, bonuses and any other benefits received from the corporation,
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX + (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
Smith Marv E.
FILE NUMBER
1. Name of Partnership
Address
Date Business Commenced
Business Reporting Year
City State
2. Federal Employer 1.0. Number
3. Type of Business ProducUService
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
Zip Code
5.
A.
B.
c.
D.
6. Value of the decedent's interest $
7.
Was the Partnership indebted to the decedent?
If yes. provide amount ot indebtedness $
Was there life insurance payable to the partnership upon the death of the decedent? ........ 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
DYes 0 No
. . 0 Yes 0 No
8.
9.
If yes, 0 Transfer 0 Sale
Percentage transferred/sold
Consideration $
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death?, , . 0 Yes 0 No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? ........,..".........""........ 0 Yes 0 No
If yes, provide a copy of the agreement of sale. etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................. 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
Date
13 Was the decedent related to any of the partners? ................................ 0 Yes 0 No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-l or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX + (6.98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Smith Marv E.
FILE NUMBER
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Smith Marv E.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1995 Buick Skylark 2,512.00
2. Pennsylvania State Employee's Credit Union 38.46
Savings Account
3. Members 1st Federal Credit Union 8,763.42
Investment Savings Account No. 1767105
4. Members 1st Federal Credit Union 40,036.59
Certificate of Deposit Account No. 1767145
5. The Patriot News 19.90
Refund Check
6. Haar's Inc. 758.25
Proceeds from Auction of Personal Property
7. Verizon Refund Check 3.74
8. Bethany Towers 53.45
Security Deposit Refund
9. AllState Refund Check 191.10
Auto Insurance
10. Ohio Casualty Group 39.00
Refund of Unused Car Insurance
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
52415.91
REV-1509 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Smith Marv E.
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. William J. Light, Jr.
6220 Warren Avenue
Lingelstown, PA 17112
Son
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A Members 1st Federal Credit Union 6,002.54 50. 3,001.27
Savings Account No. 1767100
0.00
TOTAL (Also enter on line 6, Recapitulation) $ 3 001.27
(If more space is needed, insert additional sheets of the same size)
REV.1510 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Smith Marv E.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 11hrough 4 on the reverse side of the REV.1500 COVER SHEET 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 THE DATE OF TRANSFER ATTACH A COPV OF THE DEED FOR REAL ESTIl.TE VALUE OF ASSET INTEREST VALUE
IIFAPPLICABlEj
1 N/A 0.00 O. 0.00 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Smith Marv E.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. Neill Funeral Home, Inc. 7,426.40
2. Paxtang Cemtery (Grave Opening) 925.00
3. Reverend James Browning 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) William J. LiQht, Jr. 0.00
So~al Security Numbe<<s)JEIN Numbero! Personal Representative(s)
Street Address 6220 Warren Avenue
City LinQelstown State PA Zip 17112
Year(s) Commission Paid:
2. Attorney Fees Baturin & Baturin 3,800.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 0.00
Claimant NtA
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 75.00
5. Accountants Fees Nt A 0.00
6. Tax Return Prepare~s Fees Craig Kern 200.00
7. Cumberland County Register of WillS - Short Certificates 40.00
8. The Patriot News (Legal Advertisment) 132.60
9. The Cumberland County Legal Journal (Legal Advertisment) 75.00
10. Cumberland County Register of Wills (Copies) 3.00
TOTAL (Also enter on line 9, Recapitulation) $ 12 777.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Smith. Marv E.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DESCRIPTION
VALUE AT DATE
OF DEATH
Boscov's Credit Card
328.07
JC Penney Credit Card I Stonebridge Insurance Policy
8.48
WalMarl Credit Card
211.27
HealthSouth Rehabilitation Hospital
Daily use of Television
5.30
Verizon
Telephone service
16.56
Bethany Towers
Final Rental Payment
187.00
Pennsylvania State Employees Credit Union
VISA
96.30
U-haul
packing supplies
72.93
Commonwelath of Pennsylvania
Transfer fee for 1995 Buick Skylark
28.50
BankOne - Mastercard
273.56
TOTAL (Also enteron line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
1 227.97
REV.,513EX.I,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
"mith " ,n, E.
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include OU~hts~ousal distributions, and transfers under
Sec. 9116 (a (1. II
1. William J. Light, Jr. Son 100%
6220 Warren Avenue
Lingeltown, PA 17112
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. N/A 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. N/A 0.00
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev.1500 Cover Sheet
FILE NUMBER
Smith Marv E.
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will
o Intervivos Deed of Trust 0 other
OUfeor o Term of Years
OUfeor DTermofYears
DUfe or DTerm of Years
OUfeor DTermofYears
1. Value of fund from which life estate is payable. .
. .. $
2.
Actuarial factor per appropriate table . . . . . . . . . .
Interest table rate - 0 3 1/2% D 6% 0 10%
o Variable Rate
%
3. Value of life estate (Line 1 multiplied by Line 2) .......................................... $
OUfeor OTermofYears
OUfeor DTermofYears
OUfeor DTermofYears
OUfe or OTerm of Years
1. Value of fund from which annuity is payable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . , . . . . .
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( )
3. Amount of payout per period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
4. Aggregate annual payment, Une 2 multiplied by Utle 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .
5. Annuity Factor (see instructions)
Interest table rate - 0 3 1/2%
06%
o 10% 0 Variable Rate
%
6. Adjustment Factor (see instructions). . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is : Line 4 x Line 5 x Line 6 ..........................., $
If using variable rate and period payout is at beginning of period, calculation is :
(Line 4 x Line 5 x Line 6) + Line.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting life or annuity interest{s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX + (3-84)
'* INHERITANCE TAX
SCHEDULE 'L'
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION
INHERITANCE TAX. RETURN
RESIDENT DECEDENT OF TRUST PRINCIPAL FILE NUMBER
I. Estate of !':mith M"rv i=
(last Name) {First Name) (Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisio
of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II. Remainder Prepayment:
A. Election to prepay filed with the Register of Wills on
(attach copy of election) (Date)
B. Nome(s) of Life Tenont(s) Dote of Birth Age on date Term of years income
or Annuitant(s) of election or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate $
2. Stocks and Bonds $
3. Closely Held Stock/Partnership $
4. Mortgages and Notes $
5. Cash/Misc. Personal Property $
6. Total from Schedule L- 1 $
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities $
2. Unpaid Bequests $
3. Value of Unincludable Assets $
4. Total from Schedule L-2 $
E. Total value of trust assets (Line C-6 minus Line 0-4) $
F. Remainder foetor (see Table I or Table II in Instruction Booklet)
G. Taxable Remainder value (Line E x Line F) $
(Also enter on Line 7, Recapitulation)
III. Invasion of Corpus:
A Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Bi rth Age on date Term of years income
or Annuitant(s) corpus consumed or annuity is payable
C. Corpus consumed $
D. Remainder factor (see Table I or Table II in Instruction booklet) $
E. Taxable value of corpus consumed (Line C x Line 0) $
(Also enter an Line 7, Recapitulation)
ns
REV-1645 EX + [3-84] INHERITANCE TAX
SCHEDULE L-l
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -ASSETS- FILE NUMBER
.. Estate of Smith M"rv ~
(last Name} (First Name) (Middle Initial)
II. Item No. Description Value
A. Real Estate (please describe)
Total value of real estate $
[include an Section II, Line C-l an Schedule L)
B. Stacks and Bands (please list)
Total value of stacks and bands $
{include on Section II, Line C-2 on Schedule Ll
C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2)
(please list)
Total value of Closely Held/Partnership $
(include on Section II, Line C-3 on Schedule L)
D. Mortgages and Notes (please list)
Total value of Mortgages and Notes $
(include an Section II, Line C-4 on Schedule Ll
E. Cash and Miscellaneous Personal Property (please list)
Total value of Cash/Misc. Pers. Property $
{include on Section II Line C-5 on Schedule L\
III. TOTAL (Also enter on Section II, Line C-6 on Schedule Ll $
(If more space is needed, attach additional 8'/2 x 11 sheets.)
REV.1646 EX + (3.84) INHERITANCE TAX
.. SCHEDULE L-2
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN -CREDITS- FILE NUMBER
RESIDENT DECEDENT
I. Estate of Smith M"rv E.
(last Name) (First Name) (Middle Initial)
II. Item No. Description Amount
A. Unpaid liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L- 1 (please list)
Total unpaid liabilities $
(include on Section II, Line 0-1 on Schedule L)
B. Unpaid Bequests payable from assets reported on Schedule L-l (please list)
Total unpaid bequests $
(include on Section II, Line 0-2 on Schedule L)
C. Value of assets reported on Schedule L-l (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, Line 0-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line 0-4 on Schedule L) $
(If more space is needed, attach additional 81/2 x 11 sheets.)
REV.1647EX..
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Check Box 4a on Rev.1500 Cover Sheet
FILE NUMBER
ESTATE OF
Smilh Marv E.
This Schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
D Will D Trust D Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawai within
9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
D Unlimited right of withdrawal D Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest ....... ... ... ............. ...... ... ... ..... ..... ..$
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) ......$
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One D 6%, D 3%, D 0% ................$
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One D 6%, D 4.5% ..... ............. ....$
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also inciude as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ......$
7. Totai value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ... ...... ..... ..... ..$
(if more space is needed, insert additional sheets of the same size)
REV-1648 EX (11.99)(1)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
ESTATE OF I FILE NUMBER
Smith Marv E
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DATES OF DEATH 01101192 to 12131194)
PART I. CALCULATION OF GROSS ESTATE
1. Taxable Assets total from line 8 (cover sheet) .......................,..............................................................
1.
55378.18
2. Insurance Proceeds on Life of Decedent ..............................................................................................
2.
3. Retirement Benefits........................................................ ........................ .......................................
3.
4. Joint Assets with Spouse ......................................................................................................................
4.
5.
PA Lottery Winnings .......................................................................................................
5.
6a. Other Nontaxable Assets: List (Attach schedule if necessary) H
6a.
6b.
6c.
6d.
6.
SUBTOTAL (Lines 6a, b, c, d) ...................................................................
6.
7. Total Gross Assets (Add lines 1 thru 6) ...............................................................................................
7.
55378,18
8. Total Actual Liabilities............................................................................................................................
9. Net Value of Estate (Subtract line 8 from line 7) ................................................... ...............................
If J'n 9' g I r th $200 000 STOP The estate is not er ible to claim the c dit If at in to Part /l
8.
9.
55,378.18
PARTlI . CALCULATION OF JOINT EXEMPTION INCOME . (Attach copies of Federal Individual Icome
Tax Return for decedent and spouse.)
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse. ....... ........ .......... la. 2a. 3a.
b. Decedent ... .. ... .. ........... lb. 2b. 3b.
c. Joint ......... ........ ........ ..... Ie. 2c. 3c.
d. Tax Exempt Income ... ..... Id. 2d. 3d.
e. Other Income not
listed above. ......... ..... Ie. 2e. 3e.
f. Total...................... .......... H. 21. 31.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(11)
+ (2f)
+ (31)
(+3)
4b.
Average Joint Exemption Income.......................,...............................................................,.......................
If line 4(b) is greater then $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part 1II.
=
PART III . CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES
1.
Insert amount of taxable transfers to spouse or $100,000, whichever is less .....................................
1.
2.
3.
Multiply by credit percentage (see instructions) ...................................................................
This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. ............................................
For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate................................................................................... ..............................
Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet ...
2.
3.
4.
4.
5.
5.
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