The URL can be used to link to this page

Home My WebLink About05-19-05 , . ReV- 1 S~{, EX. ,:f-.']O:', '*" COMMONWEALTH OF _' PENNSYLVANIA .: 'illil... DEPARTMENT OF REVENUE '. DEPT 280601 "' . . HARRISBURG, PA 17128-0601 I- Z W C W U W C DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL) REV-1500 PH ,_~l/~,L INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2 1_ -D- 5... COUNTY CODE YEAR [L3.~~_ NUMBER SOCIAL SECURITY NUMBER IL-I-;flrn f, DATE OF BIRTH (MM-DD-YEAR) lif1:< 073 It C-oJliJJfI DATE OF DEATH (MM-DD-YEAR) Id-. 01- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ,.. ::.::~(/) u"'''' wo.u ,,00 U"'''' 0."' 0. <( G()!IILUA'/ D 1. Original Return D 4. LimiledEslate D 6. Decedent Died Testate iAttach GOPY of Will) o g. Litigation Proceeds Received IV1 IT R- Y A, D 2. Supplemental Return D 4a. Future Interest Compromise (cafe of death a~er 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95) D 3. Remainder Return (date 01 death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST8ECQMI'l.I!;rEIl, ALI..CORRESPOMi) NAME 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule 0) 5 Cash, Bank Deposits & Miscellaneous Personal Property Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) !;;: D Separate Billing Requested ..J ::l 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G or L) a: <C 8 Total Gross Assets (total Lines 1-7) U 9. Funeral Expenses & Administrative Costs (Schedule H) W II:: 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) ,.. z w o z o 0. "' W '" '" o u z o !;;c I-' ::l II.. ::! o u >< ~ FIRM NAME (If Applicable) TELEPHONE NUMBER \") r',,) (11) (12) (13) ~~, ;;61- /36 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) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .0 (15) D 15. Amount of Line 14 taxable at the spousal tax tfl I 3Li rate. or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rale 17. Amount of Line 14 taxable at sibling rate 18 Amount of Line 14 taxable at collateral rate 19 Tax Due x .0 (16) x .12 (17) x .15 (18) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (19) () Decedent's Complete Address: STREET ADDRESS 3" dJ. (, SoutH UhsT S, R~~I . CITY <!ftl!-L-1S/.-f& I STATE ffl- I ZIP j7C/3 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. 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 a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This IS the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5A) (5B) 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;.. .................................................................. D ~ b. retain the right to designate who shall use the property transferred or its income; .. .. ....... D ~ c. retain a reversionary interest; or.... . ... ....... ........ 0 ~ d. receive the promise for life of either payments, benefits or care? ............................................................. ....... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .... . ............................ D !8.1 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. .... D EI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Ur1der penalties of perjury, I declare that I have examir1ed this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of pre parer other than the persor1alrepresentative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSla FOR FILING RETURN ADDRE~ :J. 6 Jt=~ tU.d fl. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE &~, If! 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 transfers to or for the use of the surviving spouse is 3% [72 PS ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers 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)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [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% [72 P.S. ~9116(a)(1.3)1. 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. lEV-1511 EX+ (12-99) _ '- ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FilE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~~r~) l~~~ .~ 1i JI 3 (JJ,- 1 /~ ~'V~~ 559 Ccit. 'i~~~' B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number 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 /1A III &Q, Y f/ ~ 0 NwfI i c - I StI'cIU'-T Street Address b- c!2..6 J 0(/1 If t1h 5 T City ~L-[S~-~ -- State ~Zip 1719 /_"3 Relationship of Claimant to Decedent S pO LJ GIS 4. Probate Fees 5. Accountant's Fees 6 Tax Return Preparer's Fees 7 ~ kLi5( ~h '30 APj) J; IS Ut) T~;T TOTAL (Also enter on line 9, Recapitulation) $ / f?6 f Debts of decedent must be reported on Schedule I. it (J;) (If more space IS needed, Insert additional sheets of the same size) Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 368 5/19/2005 WILLIAM E CONWAY 21-05-0382 MARY CDNWAY 526 SOlm-[ WEST ST JA CARLISLE, PA 17013 15.00 Total $15.00 Qty 1 Fee Description Additional Probate Fee Total: $15.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you.