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Home My WebLink About09-24-15 (2) . J �pennsytvania 15 0 5 61410 5 �,�.�� EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY eureau of Individual Taxes �NHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 --_ --- , -----.--__._ Harrisburg, PA 17128-0601 RESIDENT DECEDENT '' ��/f!f/�'p� � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ __— _�.— _- - _ � ____ ___ _ __ . __ � 2�-0 / � - i -.-- - -.--_. __ ..__ Suffix DecedenYs First Name M� -- - - ___ _..._ _ _-- _. , _ __ _ - �_._� � ��S � � ---, —-—------ -..___ _ /�/�-,2.D ', '�'; . ____ _ __ , -_ _ _. _ _ _ __ - _. ___.___ If Applicable)Enter Surviving Spouse's information Below � Spouse's Last Name Suffix Spouse's First Name M� ' � � , � ._._ ____v--_.._ _ . __. __ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FI�L IN APPROPRIATE OVALS BELOW � 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) O 4.Agricuiture Exemption(date of � 5.Future Interest Compromise(date of � 6. Federal Estate Tax Retum Required death on or after 7-1-2012) death after 12-12-82} O 7. Decedent Died Tesiate p 8.Decedent Maintained a Living Trust _(,Z 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) t p 10. Litigation Proceeds Received p 11.Non-Probate Transferee Return p 12. DeferzallElection 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 T0: Name - ---- -- Daytime Telephone Number _.__ __.__. __. _ __ ._. ; _ __.. - _. ' G�Dw��e ,T' �Ilc.-'"zr—wSKi ; � � -__ _ -- __ .� T� _ 'y �� -7J'`� //ZS � - - .-- _ _ _ First Line of Address - -- - _ ___�..�_. _._ ._. -- ____.__ ._---_ . _ _ _._...._.. _..- a �� /3�,'� ,��,� ,� _ ___ -- - -- _-- • _ _ _ econd Line of Address - -__ __ ___ _ _ _ __ _... _ _ - _ __ , City or Post Office State ZIP Code _ _.__ - -- -— - - _ __ ._.__ ' �llffi�7�' �/i9-LL - ; __ _ _ __ ' JJ�D.; ; Z// � / � -- ____ __________. _.�.. Correspondent's email address: REGISTER OF WILLS'USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY ' • , �-.-, ._.� C�j ,�. L `�' ;,-;� i�"1 �"" � DATE,'H(LED STiA - f,- �i � ..-- ..i �, , r . "r ._.... N , : ,.1 _,.. ,. , � PLEASE USE ORIGINAL FORM ONLY _ Side 1 ` --r, ; . � _ � -:, I�"I'I I�"I IIII�' I'I'�� I) I��'I�"'I II'll"�'�'I�)�I�� ~ -- �;� �� L �5��41�5 15 r, �� 056�105 J `� ;I • ! � 15�5614205 REV-1500 EX(FI) DecedenYs Social Security Number DecedenPs Name: �� L�. /��'�� _. RECAPITULATION �_ -- - ... _ _ _--�� 1. Real Estate(Schedule A). . . . . .. .. . . .. .. .. .. .. .. . . .. .. . .. .. . .. . . . .. .. . 1. � / S 8 �d D �- 2. Stocks and Bonds(Schedule B) . . . . .. . . . . . . . . . .. . . . . . . . .. .. . . . .. .. . .. . 2. i - 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . .. . 3. :' _ �_. a,.�.�.�. .. _�... �.. ...M_ , e s___._ . � E 4. Mort a es and Notes Receivable Schedule D ` ✓ ' 9 9 � ) . . .. .. . .. .. . . . . .. ... . . . . .. . 4. i . � _ mu __�. w.e�.._ . �_ 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. . . 5. f^� ��, --- ', 6. Jointly Owned Property(Schedule F) O Separate Biiling Requested . .. . . . . 6. � �_ _ -- -- 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ; (Schedule G) O Separate Billing Requested.. . . . . . . 7. i � �.._.. _,__ _. , .�s�__.__ .... � . v. ....a, _�. 8. Total Gross Assets(total Lines 1 through 7).. .. .. . .. .. .. . . .. .. . .. . . . . . 8 : � o v� 7i'7/� • �- i � 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . .. . . . . . . . . .. . 9. � -�' ; . � _ _P';. ��.�z 3�' -- 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . .. . . . . . . . . . 10. k $3 965, `� N_ .. �. _u___,�,,.� ,,/ m _ .. �__._ , _._ ; 11. Total Deductions(total Lines 9 and 10).. . .. .. . . . . . .. . .. . . . . .. .. .. . . .. 11 ; � �� 9a. � .._��_. ��___ .__�..�__ __ __� � _�_ _ , 12. Net Value of Estate(Line 8 minus Line 11) .. .. .. .. . . . . .. . .. ... .. .. .. .. .. 12. �,�j� � v0, � i 13. Charitable and Govemmental BequestslSec.9113 Trusts for which i� `�`~� � ' ��`'�" _° ` .."`� " ` an election to tax has not been made(Schedule J) .. .. . .. .. . . .. .. . .. .. . . .. 13. � � ' � ..___.,._ �_7.�r..�(O.d��... _.___.. 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .. . . . .. ... . .. .. .. . . . . . 14. ' ��J �QQ,�" ' TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 i _ _ ; :_ _ _ �a)�1.2)X.0- ! 15.': � _�..k_. ,., �_� ,�e.�_. _ .PA,_v. , .�, u...�.. .�,_ . _..r�., __. �W _.. __ 16. Amount of Line 14 taxable at lineal rate X .0_ 16. '; ' _.�.�.�. ., __,..�� .� .__m ��.. w,_.m.aa. „ N..�. � , .. . ..._,,._.. a ..�_ _. 17. Amount of Line 14 taxable at sibling rate X.12 �7, !, _ --,_� __....,.. . �. . _ ,�,. ___ _ �,. _ , 18. Amount of Line 14 taxable �� .. ,� �� at collateral rate X.15 � �5,(�U ; �g, ��Z `J• _ ._� .a_w. _._ .. .....�.__ 19. TAX DUE .. . . . . . . . . . . . . . . . . .. .. .. . . . .. .. . . . . .. . . . .. .. . .. . . . .. . .. . . 19. ; 8 �D�� ' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p 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. SIGNAT OF PERS SP SIBLE FOR IN ETURN DATE . • 9-�a /3� ADDRESS �I / /C T/��c//1 "�G T � �/� I !6 ,�'L �D. ��I[�� SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS I��I�I I��I��I�I�'I�I'�I��I�'�(I�II��'II��I��III I�� Side 2 � 1505614205 15056142�5 � f..EV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 2/�,�f --/Z o l DECEDENT S NAME -- _— ��.�20 __ L'_� _�l�t`.¢5____ STREETADDRESS _. .. ..........— _ __.. /S/�'_ /t�e�Q�1-CE�' __ ff'-v� CITY � STAT�� ZIP/ �u/� Cf1�-� 5 L r y�� , Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) �� "'—' 2. Credits/Payments A.Prior Payments B.Discount -...............-- -__...._....._.--— �._--., (See instructions.) Total Credits(A+B) (2) 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) 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) O ��,�" Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did tlecedent 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?...................................................................... ❑ ,� 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 6�1 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �. 4. Ditl 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 imposetl 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 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-isoz Ex+ �rz-iz) � pennsylvania SCHEDULE A DEPARTMENTOFREVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: �i�is��ao �'. �y��es �i�� -- ��2 0� 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 property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION �. ��/5"f �v�. �''�ec�s.�e; P,9 >7ai.� �sg �oo,— TOTAL(Also enter on Line 1, Recapitulation.) $ �3�'t�l UD,�� If more space is needed, use additional sheets of paper of the same size. REV-i5o8 EX+(o8-u) �pennsylvania SCNEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: � �� C� � ��5 FILE NUMBER: �// � - i20 / Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyr jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. � /T! 2.l'%�J�-s l.S�•J/�C. _ �g ��{.��,� ��[ �/-71�C'�3 L'Q t�/%c/•v�cL� �.14�"'i /�ra aN�'" s'i5"�, y� 8�� '7.��73 3 ��,�� T��. �� d F � � � n �o� �d !-� 5 � ��ih L N s u h�falJcr /2�:��'c� •�1� l ?t� • �L TOTAL(Also enter on Line 5, Recapitulation) $ �� g��, � If more space is needed,use additional sheets of paper of the same size. REV-.t511 EX+ (08-13} � pennsylvania SCHEDULE H DEPARTMEMOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXREiURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF �� -y� FILE NUMBER �� '/�"`�C " `2 d 7 Decedent's debts must be reported on Schedule I. ITEM NUMBER A• FUNERAL EXPENSES: DESCRIP7ION 1 AMOUNT �=kiiti6 �3�Ti�>-� �T ��—��s ��,�� 99 o y. — � vdo. — B• ADMINISTRATIVE COSTS: 1• Personal Representative Commissions: Name{s)of�ersonal Representative(s) ��/,(J�� / • /11�r�jl�� j�• ('�Jl�["D -.►T 07 6/q �3� -D -- ---- �� . Street Address__ _ �-- ��'�L Q/f 7 � �`Y�' City �'1 ]� _�_L--------__State /� � ZIP 2/�d/ Year(s)Comcnission Paid: e2D�,� 2• Attorney Fees: �1 � '�� 3• Family Exemption: {If decedent's address is not the same as claimant's,attach explanation.) Ciaimant Street Address City_ — — _ 5tate Zip Relationship of Claimant to Decedent 4• Probate Fees: ��/�'„�. 5� Accountant Fees: 6� Tax Return Preparer Fees: ��.�' 7. ��f TOTAL(Also enter on Line 9, Recapitulation) $ ��1�" If more space is needed,use additionai sheets oP paper of the same size. REV-1512 EX+(12-12) � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF • FILE NUMBER ��1� �� y�—�s ,�.,� -�z�� 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 �. ,(j�t/y �'J1�=Zt,o.� ,c�l� - h�a�yr` r��,'ty- !�6 �.2, .._. 2 �/SQ`1!/� �Q'�"_ 3 t�.'�yr� /�r�- C T.� . / 2�6.— 11 ('.u�1.... ,�c—�- �'�6kG�5� o�%ZSV• " ? � �Q�,— S� .�N�`u�'Le� �'Qr�l�a,n -� ,e�� w.�-� ��r�� ,�Fi°^'►a.s, �I�,crr�i •�,�� Z� i 7. �N�/��'�.Y 4� ,Di�TxiP✓�na.� t>F Y��PE�7'y �D C'�iT'� � � "f'kf0 Gt�d l2KC'�S � '4��b f�u,�3 ��J-d0� F�iY��7�h�,Q. ��D S� g Pc�i so.�.e�-� ��=o�-c. �.t-x�s ��/, _ �' {��v�'� �-'��/ S��'� :�PS ,2� �,yr,r- ' , �j 5'3.�- �o• ,�r�-�-- c�--rr .��'�''�- �.�s. 13 TOTAL(Also enter on Line 10, Recapitulation) $ O 3 ` �P v . d� If more space is needed, insert additional sheets of the same size. . R�V-1513 EX+(O1-10) �_ . � � pennsylvania SCHEDULE ] '� DEPARTMENT OFREVENUE INHERITANCE T/U(RETURN B E N E FICIARI ES RESIDENT DECEDENT ESTATE OF: ` FILE NUMBER: �/C�A��/� r', /Lj� —'fl�S [��F� 12 o I RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Oo Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).J n�t�� v� i. W !�.L/�� f��,�s �.> _. ,Yr'�� . �� c/ iNi�t r.f /� �ff'�'��"� f/r�7°N�.7� � b. LL � �,✓�L��rt-A►'► Fi��l�� , ��r C� 16 , (( s� ��ori�iiU� C° . �'�1G''Zr�✓�.�� ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEEf,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 3Q`' ;�� .s' �. �itBN I Tit�t� �i�U� 3 -tg �a�J1►l ��6�«f �S f'�vC�cvDfs 3 • Fu// �t3c-� i�oM. �c�T? ��,�'l�e3 �l' _ � �t c �UJni iN 6 .�'r!s .�c�7', ��v iiN� i�''rr`� ��v L'Ke,!i¢S• J�so /d, `�o d. �t'�C�.��ti� � L�f�� T�-dLe�"Sj D/�/f'S/ ✓�GZsc.PiN� .�d -�iB�. a ca,Ti�,•Nt �; �s�� • ?�• � us� L,a�¢��, � a o o. ,-- ��'S /.� -h/iNit1� �ifiiS, .�3-tn•'� > •;� ,�,��s �r��, �� mo�r � w��fw w��s �N�% . �� G C [�FiP6�I��i1��7b ��//�/�A r$¢lI�' �Dd�G✓l G�� .� S/��P � ��"�� TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 6O v� �—' If more space is needed,use additional sheets of paper of the same size. .,i ,�_ � y. . ;�� ; � � ��::rF ��.� , ��•��:. � � �.( � d.�a�,�.. Y'��t r � �L.{�.�y,..� e . ,�I� E�4 ��•� '� �* a a.�.; .�`� ^�, C•. ,1�> 7. R�g,i ��e�r� '��'. ��.7 �'ia�:i�`��.. ;�i.A�1'��,.).�,.:7i�'�.r 6`�--T..':!C9Ey.'�7�,` ., ��., -� � W � � � O t.� 2 O C'? �V _ � N l.J _.1 .�-1 d �� c�, �._ w O � 4,- � i � O�Z�U' o c_ � � Uwr� s . . T _... ` ._ , c,s , c : C� � ZOa ( � �� ci._ ' _�1 g �g z W W �F-' J �� ;, f � :W: QI- W � fn C� �:,; _� � t� m � J L:.] , �f? CJ J (� �O � � .__ i_.., (n W �V Q � � U r U ^"K � a > a � o >.� H � o � �� -1 a o-y �°D„ � n „%� � W