HomeMy WebLinkAbout01-0525
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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FiLE NUMBER----..------------.-.---.-- -
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DO-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
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COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
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NUMBER
o 3. Remainder Return (dale of death prior to 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) (AltachSchO)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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(8)
(11)
(12)
(13)
(14)
(19)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~ ~ BE SURE TO ANSWER All'QUESTIONS ON REVERSE SIDE AND RECHECK MATH < '"
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THISSEc:T10N MUSTiSE COMPJ.:EJEO:ALL CORRESPONbEtilCE~NO _CONFJfiE:NTJ~L:;TAX INFPRMAT!OjlfsHOli~D BEl>IRECTED TO,~
NAME COMPLETE MAILING ADORESS
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~ 1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest CDmpromise {dale oj aeath alter 12. t2-f12)
o 7. Decedent Maintained a Living Trust (Artach copy of Trusl)
o 10. SpDusaJ Poverty Credit (dale o{death between 12-31.91 and 1.1.95)
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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. tnter7Wms Transfers & Miscellaneous Non--Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(I)
(2)
(3)
(4)
(5)
~2, 9:t:tJ. ()Lf
OFFICIAL USE ONLY
~t- 2(.>3.6V
'13"1'-:;- 3'k.
In 9';7.'>'ii
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3 Jq"oq
(6)
(7)
(9)
(10)
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9. Funeral Expenses & Administratil/e Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 ta:<.able at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x_O_ (15)
x ,0 "z:L (16)
x _12 (17)
16. Amount of Line 14 ta:<.able at lineal rate
?~ qS? t.~R
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14laxable al collateral rate
x _15 (18)
19. Tax Due
De'cedent's Complete Address:
STREET ADDRESS ;1. J/lQ _1"-
r:JO~?,'::...jf ~ I),.
CITY Ca.,.,..,_"" I STATE I ZIP
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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:
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; Of........ ................. ............................
d. receive the promise for llfe of either payments, benefits or care? ..
2. If death occurred after December 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? . ..................... ................
Ves
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...........0
............0
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE iT AS PART OF THE RETURN.
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SIGNATURE OF PERSON RESPONSI
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.
Declarationofpreparerotherthanthepersonalrepresentabveisbased on all information of which preparer has any knowledge.
ADDRESS
"116'i ('...Ac..- /2.(", 1),..,';<,- Cc~, #71 (J4 n>!)//
SiGNATURE OF PREPARER OTHER THAN REPRESENTATIVE '
DATE
.J -021-0 L
ADDRESS
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse (s 3%
[72 PS 89116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on Ihe net vaiue of transfers to or lor the use of the survivin9 spouse is 0% [72 P.S. 89116 (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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a slepparent of the chiid is 0% [72 P.S. 89116(a)(1.2)].
The tax rate imposed on the net value o( transfers to or (or the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 89116(1.2) [72 P.S. 89116(a)(1)].
The tax rate imposed on the net value at transfers to or for the use of the decedent's siblings is 12% [72 PS. 89116(a)(1.3)]. A sibling is defined, under Secllon 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.1S0:C=y'+:'97l .' ~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
AJ?~(,~, ( I<.aiA'"
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 \l1e relevaftt facts. Real property which is jointly-owned with
right of
survivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
R.ES" ,j)Ei>JcL
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SeAe_ c,hd.-,R c,'P~,h:J. N.fGr-;-.
6~ SiXl
TOTAL (Also enter on line 1, Reo.pilul.lion) $
(If more space IS needed, Insert additional sheets of the same slze)
S'l5'1':JO
,REV.l~3Ex+(1:97)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES1DENT DECEDENT
ESTATE OF
FILE NUMBER
A~l' /,.( r. R."....,.,.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1,
DESCRIPTION
VALUE AT DATE
OF DEATH
NIt:>
TOTAL (Also enter on line 2, Recapitulation) $ /viA
(If more space is needed, insert addilional sheets of the same size)
REV-150' EX+ (1-97) 9"!~_Q_
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF
FILE NUMBER
AcP,l.o__ (', {(ex..=
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
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
1,
DESCRIPTION
VALUE AT DATE
OF DEATH
IV)/;
TOTAL (Also enter on line 3, Recapitulation) $ N !A-
(If more space is needed, insert additional sheets of the same size)
REV-15"5EX+(1-97)
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SCHEDULE C.1
CLOSELY-HELD CORPORATE
STOCK INFORMA lION REPORT
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1. Name of Corporation
Address
City
2. Federai Employer i.D. Number
3. Type of Business
Zip Code
State of incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
State
Product/Service
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide ail rights and restrictions pertaining to each ciass of stock.
5. Was the decedent employed by the Corporation? 0 Yes o No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to toe decedent? 0 Yes o No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the pelicy
8. Did the decedent seil or transfer stock of 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
Attach a separa1e sheet for additional transfers and/or saJe~.
Consideration $
Date
9. Was there a written shareholders agreement in effect at the time of the decedenrs death?
if yes, provide a copy of the agreement
DYes 0 No
10. Was the decedent's stock sold?
DYes
o No
If yes, provide a copy of the agreement of saie, etc.
11. Was the corporation dissolved or liquidated after the decedenrs death? 0 Yes 0 No
If yes, provide a breakdown 01 distributions received by the estate, including dates and amounts received.
12. Did the corperation 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.
A. Detailed calculations used in the valuation of the decedenrs stock.
8. Complete copies of financial 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 valuels. If real eslate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their reiationship 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.
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SCHEDULE C.2
PARTNERSHIP
INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE lAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
1. Name of Partnership
Address
City
Date Business Commenced
Business Reporting Year
Slate
Zip Code
2. Federal Employer LD. Number
3. Type of Business ProducUService
4. Decedent was a 0 General 0 Umited partner. If decedent was a limited partner, provide inilial investment $
5.
PERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent?
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? 0 Yes 0 No
II yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
DYes
o No
9. Did the decedent sell or transfer an interest in this partnership within one year prtor to death or within mo years if the date of death was prtor to 12-31-132?
DYes 0 No II yes, 0 Transfer 0 Sale PercentagetransferredJsoid
Transferee or Purchaser Consideration $ Date
Attach a separate sheet 1m additional transfers and/or sales.
10. Was there a wrttten partnership agreement in effect at the time of lhe decedenfs death?
If yes, provide a copy of the agreement
o Yes 0 No
10. Was the decedent's partnership interest sold?
If yes, provide a copy at the agreement of sale, etc.
11. Was the partnership dissolved or liquidaled after the decedent's death? 0 Yes 0 No
If yes, proVide a breakdown of distribulions received by the estate, including dates and amounts received.
DYes 0 No
12 Was the decedent related to any ofthe partners? 0 Yes 0 No If yes, explain
13. Did the partnership have an interest in other corporations or pannershlps? 0 Yes 0 No
If yes, report the necessary information on a separate sheel, inciuding a Schedule C-l or C-2 for each interest
A Detailed calculations used in the vaiuation at the decedent's partnership interest
B. Complete copies of financial statements or Federai Pannership Income Tax relums (Form 1065) forthe year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complele address/es and estimated fair mar1<et valuels. If real estate appraisals have been
secured, attach copies.
O. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX+ (1-97}
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
FILE NUMBER
AI":{)~ fl'1~ r :i)OI...f~
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
IV/A-
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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RE':j~""lj''''..
COMMONWEALTH OF PENNSYLVANlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
~f2el.~<, r. 7:!"",-,,-,,, :lJ-t'lI-OS>.:f
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
I.
DESCRIPTION
VALUE AT DATE
OF DEATH
l"te,.,be-, I." r-. c. I,A .
Sa.Vl:i:)S- t:..c..""",.......:r
4c "" ;J.(),,?'-:1;l-O
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W"',;/p";' I- 13",,1<:
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A.." n.2n091..
$,4J9. I'(
'?<--~ .1"of'\"A 'c.:f"~c t.-.j.;s
p~ c/.led.."" $eh...li"",e 'il, ,~.=
TOTAL (Also enter on line 5, Recapitulation) $ ') 2 if!);. ~
(If more space IS neeow, insert e<Jdilional sheets of the same size)
:':E'I.\511.liX.(1-97)
.
SCHEDULE F
JOINTL Y.OWNED PROPERTY
COMMONWEALTH OF PENNSYl.VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
ArPn 1,,,-,, ('
P/':l.A...<;;(t_
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11 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.
IV JI'r
B.
c.
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %Of DATE OF DEATH
ITEM FQRJOINT MADE Include name of financial institution and bank account number or similar identifying number. Atta:::h DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deedforjoindy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Iv'/q-
TOTAL(Also enteron line 6, Recapitulation) $ IV //.1-
(If more space is needed, insert additional sheets of the same size)
K"'..V'1510EX+{1'~1)....
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES1DEN1 DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
AJJ-<, /~;,. C >>O~'CL
...2 J-~)J -nO. r
This schedule must be completed and filed if the answer to any of Questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLIJDETi-'€ ,~~,ME OF THE TAANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
AITACH A COPV OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IfAPl'LlCA8LE)
NUMBER
1. NM
TOTAL (Also enter on line 7, Recapitulation) $ N'?;
(If more space IS needed, insert addlllonal sheets of the same size)
RcV.151tEX'(1-971
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE$lDEN1 DECEDENT
~rP.,' 1-:'. C /h,,_a
Debts of decedent must be reported on Schedule I.
FILE NUMBER
2.1-C;!-bSl'>
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cc..r-I+-O, 1::t.-'-'l~,..af f-foi>1-e ( II" (..
~\? /vt.c;,;" Sf. '7'95. S..
(-I,-,d2s"'~ f,,"". A)' 1'L'f.3Ci
(SO, ') ,.,,)-'-12),.,3
,s<<.. c.;f(.(.,./...,t,J',? ....~.((' fP.~f"
B ADMINISTRATIVE COSTS:
1. Personal Representative's CommisSIons
Name cfPersonaf Representative (s)
Social Security NUmber(s) (EIN Number of Personal Represerrtative(s)
Street Address
City Slate Zip
Yea~s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address ls not the same as claimant's, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees 30D
6 Tax Return Preparer's Fees
7. .A-J1;'I'-I.;.s-c..1 ,":--e.<-. :l.s-o
TOTAL (Also enter on line 9, Recapitulation) $ o~'r.('S{
(If more space is needed, insert additional sheets of the same size)
RE\I.ISI2 EX~(1-971
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
COMMONWEA.l TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
A-.dl<A..;t~ c. J?'J~~-'
1{-hf.^r-1~
Indude un reImbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
IV J/r
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
.IV/A
PE,,-\'i\3~Y,'\\-B!)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
l:t.n-IA- / 1) 'L...,"''' ]j-/J,./><-j,'
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(SI RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1, f3"'<-t<e- n."w;e 5",", I=/.
~IDc; C~dZcr {2(-"'\ Urrv<..
r7 /.././1,.24 iO/1
LC~f'
ilS-~g - ;307
(-, ,.., " ;:n- '13'n.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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,
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1,
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more spaoe is needed, insert additional sheets 01 the same size)
REV."''''.''.9n*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
FILE NUMBER
ESTATE OF
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 0 Intervivos Deed of Trust 0 Other
.. . ............ ...i.... "y'il..IF:EiE.SfA'I'E1R'I'E.RES't",CAtCU!BA'I'lb.N'ii..'Y\;; "i:,':',i:.:'
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
LIFE TENANTiS) DATE OF BIRTH DATE OF DEATH PAYABLE
o Life or 0 Term of Years_
o LifeorOTermofYears _
o Life or 0 Term of Years _
o LifeorO Term of Years _
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 031/2% 06% 010% 0 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
$
%
$
NAME(S) OF
ANNUITANT S
DATE OF BIRTH
TERM OF YEARS
ANNUITY IS PAYABLE
o Life or 0 Term afYears _
o LifeorO Term of Years _
o Life or 0 Term afYears _
o Life or 0 Term 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, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate 03 1/2% 06% 0 10% 0 Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity -If using 31/2%, 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 additionai sheets of the same size)
""'''''.'''1''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
ESTATE OF
(Ch~.ck Box 4a on Rev.1500 Cover Sheet
FILE NUMBER
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 certainly.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
I. Beneficiaries
NAME OF AGE TO
BENEFiCIARY RELATIONSHIP DATE OF BIRTH NEAREST BJRTHDA Y
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 withdrawal within 9 months
of the decedent's death, cheek the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right.
o Unlimited right of withdrawal o 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 totai shown on Line 13 of Cover Sheet) $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 0 0%
(also include as part of total shown on Line 15 of Cover Sheet) $
4. Value of Line 1 Taxable at 6% Rate
(also include as part of total shown on Line 16 of Cover Sheet) $
5. Value of Line 1 Taxable at 15% Rate
(also include as part of total shown on Line 17 of Cover Sheet) $
6. Total value of Future Interest (sum of Lines 2thru 5 must equal Line1) $
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:'~''''"'''I'''",~
~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS
ESTATE OF
FILE NUMBER
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) 01 the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form musl be filed for each trust.
This election applies to the Trust (marital, residuai A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or simiiar arrangement is listed on Schedule 0, and
b. The vaiue of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferors personai representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or
similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is Included as a taxable transfer on Schedule 0, the
personal representative shall be considered to have made the election only as to a fraction of the trust or SImilar arrangement. The numerator of this fraction IS equal to
the amount of the trust or similar arrangement included as a taxable asset on Scheduie O. The denominator is equal to the totai vaiue of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
survivina soouse under a Section 9113 (Al trust or similar arranaement.
DESCRIPTION VALUE
Part A Total $
PART B: Enter the description and value of all interests included in Part A for which the Sectian 9113 (A) election to tax is beina made.
DESCRIPTION VALUE
Part B Total $
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