HomeMy WebLinkAbout05-20-05
'lE"!_ljOC_fX;6_00
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
w
Q
w
U
w
Q
w
"'
,,_<II
,,"'''
w""
",00
,,"'~
..<II
..
'"
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
PLA.5/<.t:T Lot.) ~CN ~ 5,
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
1=28. 2 2. 0'05 111.4 Y Z 0 /q2 b
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
pL!1S;.<:E r
YrIIl!:
REV-1500
Gi:riC!/J,!.
!
hi
FILE NUMBER
2L-j)5
COUNTY CODE YEAR
O~(pi{_
NUMBER
SOCIAL SECURITY NUMBER
/35'-2.D
(>1,
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
.N 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate IAttat:-hcopy\)\W\\\)
D g, 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 T (us'!. (Allach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1.1.95)
o 3. Remainder Return (date of death prior 10 12-13-82)
D 5. Federal Estate Tax Return Required
8. Tolal Number of Safe Deposil Boxes
o 11. Election to tax under SeC. 9113(A) (AttaGhSchO)
TELEPHONE NUMBEj\,
<c5b -
35~ /5Q'7
>-
z
w
o
z
o
..
<II
W
'"
'"
o
"
COMPLETE MAILING ADDRESS
50 WI}L/lJU T
5 IJ-L e: MJ /II. J.
ST-
ott> 071~ /745
z
o
~
:)
l-
ii:
<I:
U
w
0::
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
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inler-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 Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
-T
(I) 0
(2) 0
(3) 0
(4) 0
(5) .fJ 7,13 h, 3h
(6) 0
(7) D
r--- OFFICIAL USE ONLY
1
...:j',
(9)
(10)
j}g,??71,r;so
/
(8) -J;i 7., q 3 b' 3&
o
(II) Jj B: fb 7 q, 'b 0
(12) 0
(13) 0
13. Charitable and Governmental Bequests/Sec 9113 Trusfs for which an election to tax has not been
made (Schedule J)
14 Net Value Subject to Tax (Line 12 minus Line 13)
(14) 0
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
xO_(15)
z
o
!;(
I-'
:)
ll.
:!E
o
u
X
~
15. Amount of Line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 141axable at lineal rate
17. Amount of Line 14laxable at sibling rate
18. Amount of Line 14 taxable af collateral rate
19. Tax Due
(/
D
x .0 (16)
x .12 (17)
x .15 (18)
(19)
o
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS S 2 2 - /IV / L
IT- 2/03
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
ZIP 1705~~ Uw::>
Total Credits (A+ B + C) (2) 0
3. InteresVPenaity if applicable
D.lnterest
E. Penalty
TotallnteresVPenalty ( D + E ) (3) D
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) (7
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) D
A. Enter the interest on the tax due.
o
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
o
Make Check Payable to: REGISTER OF WILLS, AGENT
-'I'~_n:III"I1I~ III1lIlAII~lllilliDl ill:"Jal"-'1ll1l1'1I1_.] IIIIJ!ll v'l1!l'll'_lllll'_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain Ihe use or income of the property transferred;.. ................... 0
b. retain the right to designate who shall use the property transferred or its income;.. .... . ....... .... 0
c. retain a reversionary interest; or... ." 0
d. receive the promise for life of either payments, benefits or care?". . ...... ................... ...... . ...... ..... 0
2. If death occurred after December 12, 1982. did decedent transfer property within one year of death
without receiving adequate consideration? .. . 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .... . ....................... 0
No
~
13
lR1
RI
~
1&
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedlJles and statements, and to the besl 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 preparerhas any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
?f- ~!J1l' ~/-k:r
ADDRESS .
So W/fLiJ t/) 5 J, 5A- Lt:I'7.. /II, v: 0 So 7 '1-/745
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
5//2/.;z ~OJ
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 tile surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (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 stepparent of the child is 0% [72 P.S. &9116(a)(1.2)).
The tax rate imposed on the net value of Iransfers to or for Ihe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116(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-1502EX'i1-97)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L.oup'~";t!'
5,
P Lf}S/<:.~r
FILE NUMBER
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 which is jointly-owned with
right of
sUlVivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
IVONe-
o
Due. 4<; CI)
Pel clo lD
fWD J5 l'D
J.t..
TOTAL (Also enter on line 1, Recapitulation) $ 0
(If more space is needed, Insert additional sheets of the same size)
REV.,50:/EX'i'.971
ESTATE OF
'*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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 which is jointly-owned with
right of
sUNivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
'REV.1503EX+{1-97)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
L D U r<. LIV I!'
s'
P L/tSJ::.eJ
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
o
;II,!} ,
TOTAL (Also enter on line 2, Recapitulation) $ D
(It more space IS needed, insert additional sheets of the same size)
REV15""+I'-92I~
~
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
Please Print ar Type
FILE NUMBER
Schedule C-1 or C-2 must be attached for each business interest of the decedent, other than a proprietorship.
LovR.i!J1IC:
.s. PL!fSJ<:ei
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
N.I}.
D
TOTAL (Alsa enter on line 3, Recapitulation) $ tJ
{If more space is needed, insert additional sheets of some size.}
REV.1505EX+ (1.9l)
'*'
SCHEDULE C.1
CLOSELY.HELD CORPORATE
STOCK INFORMATION REPORT
$/ PL(.ISK~T
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Loui<..tE~€
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Vear
1. Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
Product/Service
4.
TVPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting f Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BV THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? 0 Ves o No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? 0 Ves o No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Ves 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell 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?
o Ves 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers andfor sales.
Consideration $
Date
g. Was there a written shareholders agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
o Ves
o No
10. Was the decedent's stock sold? 0 Ves
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? 0 Ves 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
o No
12. Did the corporation have an interest in other corporations or partnerships? 0 Ves 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-l or C-2 for each interest.
;q:I:~:;:i;ilii!._.~.
A. Detailed calculations used in the valuation of the decedent's stock.
B. 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 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.
'1EV.t506EX.IT.97)
*'
ESTATE OF
LfJllf{elilE
SCHEDULE C.2
PARTNERSHIP
INFORMATION REPORT
S, P LlJ-o)GC;'
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1. Name of Partnership
Address
~ ~ ~~
2. Federal Employer 1.0. Number
3. Type of Business Product/Service
4. Decedent was a 0 General 0 Umited partner. If decedent was a iimited partner, provide initial investment $
Date Business Commenced
Business Reporting Year
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 Ihe Partnership indebled to the decedenl?
If yes, provide amount of indebtedness $
8. Was Ihere life insurance payable 10 the partnership upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
DYes
o No
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if Ihe date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Dale
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of Ihe decedents death?
If yes, provide a copy of the agreement.
DYes
o No
10. Was Ihe decedent's partnership interest sold?
If yes, provide a copy of the agreement of sale, etc.
11. 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.
DYes 0 No
12 Was the decedent related to any of the partners?
DYes
o No If yes, explain
13. Did the partnership have an ,"terest in other corporations or partnerships? 0 Yes 0 No
if yes, report the necessary informallon on a separate sheet, including a Schedule C-1 or C-2 for each interest
A. Detailed calculations used in the valuation of the decedents partnership interest.
B. Compiete copies of financial statements or Feaeral Partnership Income Tax retums (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 marne! 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-1S07 EX+ (1-97) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
FILE NUMBER
LotJR.~";[
5,
P LkS/G~/
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
tJ, .4-.
D
TOTAL (Also enter on line 4, Recapitulation) $ D
(If more space is needed, insert additional sheets of the same size)
. REV-l5OB EX+ 11_97)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
S. 'P LIf SJC€"/
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/...ou(.?en)t!:
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
1.
1..
3,
4.
VALUE AT DATE
OF DEATH
DESCRIPTION
VAIJGuARD (l1oWEY (YJ(}RJLi1 FiJrJD ttoo3D
A cc.-'l' tf cn q B 1/2 q 73
3lwnp.'1' qf CiJf>-[III'7i!. crE:i.JJI!.Lf\1
!ZJtJG-fiJ
({ I rJ C; fJ. z..
CoSJ'v!l1t!. JEJ../ELfl..Y
wl!.bDJfJG BI}J,JD
Jj J)47B,3b
.Jj 2 500
".)
11 2/,500
..11 20-0
.$20'0
Wet.l'6U...J G- (ffJPffOJ..I!:L
CdtsH I;.) (JU{l..St!:S
~ 1000
:;
.JYSB
TOTAL (Also enter on line 5, Recapitulation) $ 1. q J (" . 3 fo
(If more space IS needed, Insert additional sheets of the same size)
R'EV.10fflEX+(1.971
'*
SCHEDULE F
JOINTL Y.OWNED PROPERTY
COMMONWEALTH OF PENNSl LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LOt/ P..~/IIL
S. P'-(h5/<'~1
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.
B
c.
JOINTLY-OWNEO PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of flnancial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation) $ 0
(if more space is needed, insert additional sheets of the same size)
""";"",.,,"'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LotJf{..e/ll1!
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
5, rLfJ.5~~-r
FILE NUMBER
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 INCLUDE THE NAME OF THE TRANSFEREE. IHEIR RELATIONSHIP TO DECEDEN lANOTHEOATEOFTRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLEl
NUMBER
1,
TOTAL (Also enter on line 7, Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
~jk
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
LOtlR':::iJC.5. PL/1SfGe:,
FILE NUMBER
ITEM AMOUNT
NUMBER DESCRIPTION
A FUNERAL EXPENSES: J:j 2 )q 2.5
1 fYloiJA-HAN r-V N ~il..f1 L )fvfr}c 12.5" CA-R.LISLt::' S).
G~rrY.s t';tJR ~-' PI/- 173M
2, EV I! II. C, IZ C"C Jtj CiEmt:.-rr:.IL.Y 7qq B~LTIM/)fZt! ST-
c./!TTI(5 B r/p" 4~ P!1- 17325 .it I/~O 0
C. R{}vl!. Lor o:i- GR~/'f1(.j<1'II7,J !3vt?-,4L
3. 11-/ i! P lIu!. i.I!.Jt41JA,fl/ll1 8PtLJ'Ifl1cfl..J( P/Ke ~ -h353.6t)
[LVAJ"I.f~D;'; ) C.t!i1Y6f3vR~f4 /'732
1-. E. v/::.- P. C, /l..1!..-EA! C~Me: TIJf{Y- GdZIfVC sire' (VI it I? kl!I<..S .Y4;.zoo
B ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representatlve(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
Ci1y ________ State _ Zip
Relationship ot Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $8,S7B.So
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-1512EX-(1-97)
ESTATE OF
Lov{J..'<:NL
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
$, P Ut5 )<.1[;
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
rJ,ft .
TOTAL (Also enter on line 10, Recapitulation) $ 0
{If more space is needed, insert additional sheets of the same size)
. REv_1513EX+(1-S7)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERlT ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
l. TAXABLE DISTRIBUTIONS (Include outright spousal distributions)
1.
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 $ 0
1-.0 LJ I<.. f!:N E
5. pL!tSjC..e:r
(If more space Is needed, Insert additional sheets of the same size)
'W""EX.I1.971W
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
LOU~eN~ $, PL~S~er
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 Pubiication 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
LIFE ESTATE INTEREST CALCULATION
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
o Life or 0 Term of Years_
o Life or 0 Term of Years _
o Life or 0 Term of Years _
o Life or 0 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)
ANNUITY INTEREST CALCULATION
$
%
$
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
o Life or 0 Term of Years _
o Life or 0 Term of Years _
o Life or 0 Term of Years _
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 031/2% 06% 010% 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
-!i!-
SCHEDULE "L"
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION
INHERITANCE TAX RETURN
RESIDENT DECEDENT OF TRUST PRINCIPAL FilE NUMBER
I. Estate of
(Last Name) (First Name) (Middle Initial)
This schedule is oppropriate 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 provisions
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 (Dote)
(attach copy of election)
B. Name(s) of Life T enant(s) Date 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 S
2. Stocks and Bonds S
3. Closely Held StocklPartnership S
4. Mortgages and Notes S
5. Cash/Misc. Personal Property S
6. Total from Schedule L-l S
D. Credits: Complete Schedule l-2
1. Unpaid liabilities S
2. Unpaid Bequests S
3_ Value of Unincludable Assets S
4. Total from Schedule L-2 S
E_ Total value of trust assets (line C-6 minus line D-4) S
F. Remainder factor (see Table I or Table II in Instruction Booklet)
G. Taxable Remainder value (line E x Line F) S
(Also enter on line 7. Recapitulation)
III. Invasion of Corpus:
A. Invasion of corpus
(Month, Day, Yearl
B. Name(.) of life Tenant(.) Date of Birth Age on date Term of years income
or Annuitant(s) corpus consumed or annuity is payable
C. Corpus consumed S
D. Remainder factor (see Table I or Table II in Instruction Booklet) S
E. Taxable value of corpus consumed (line C x Line D) S
I
(Also enter on line 7. Recapitulation)
REV-1645 EX+ (7.85) INHERITANCE TAX
~k
SCHEDULE L-l
COMMONWEALTH OF PENNSYlVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -ASSETS- FilE NUMBER
I. Estate of
(Last Name) (First Name) (Middle I!\ilial)
II. Item No. Description Value
A. Real Estate (please describe)
Total value of real estate $
(include on Section II, line C-1 on Schedule l)
B. Stocks and Bonds (please list)
Total value of stocks and bonds $
(include on Section II, line C-2 on Schedule l)
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 on Section II, line C-4 on Schedule l)
E. Cash and Miscellaneous Personal Property (please list)
Total value of Cosh/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 l) $
(If mare space is needed, attach additional BY, x 11 sheets.)
REY-\646 EX+ {3-84\ INHERITANCE TAX
*
SCHEDULE L-2
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETU RN
RESIDENT DECEDENT -CREDITS- FilE NUMBER
I. Estate of "'
(last Name) -..-------..--.. (First Name) (Middle Initial)
II. Item No. Descripti.~_~___ Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule l.l (please list)
--...--.---.----- ---- - ----.-
Total unpaid liabilities $
(includeon Section ",Line D-l on Schedule l)
B. Unpaid Bequests payable from assets reported on Schedule L-1 (pleose list)
".----- -------.-
Total unpaid bequests $
(include on SecIion II, line D-2 on Schedule l)
- - --
C. Value of ossets reported on Schedule l-l {other t}lOn unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of tke trust.
Computation as follows:
-..--'.-- ---..-..-...--- "~-.,,
Total unincludable assets $
-. (i~c1ude 0", Sectio,:!.ll, Line 0-3 on Schedule L)
III. TOTAL (Also enter on SecIion 11..._l;rlO D-4~,,-Schejule l) $
(If more space is needed, attach additional 8h x 11 sheets.)
e""~m.('."(.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
ESTATE OF
Check 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 certainty.
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 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 withdrawal 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.
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 total 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 2 thru 5 must equal Line1) $
(It more space is needed, insert additional sheets at the same size)
REV.l64B EX (1-92)
~.."~ ,~q
~
SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYlANIA
INHERITANCE TAX DIVISION
ESTATE OF
AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91
LUMBER
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
PART I - CALCULATION OF GROSS ESTATE
I.
Taxable Assets total from line 8 (cover sheet)
I.
2. Insurance Proceeds on Life of Decedent
............. 2.
3. Retirement Benefits.
3.
4.
Joint Assets with Spouse
4.
5.
PA lottery Winnings
6b.
6a. Other Nontaxable Assets: list (Attach schedule if necessary).. 6a.
6c.
6d.
6.
SUBTOTAL (Lines 60, b, c, d)...
6
7. Total Gross Assets IAdd lines 1 thru 6).... 7.
8. Total Actual liabilities .. ............. ...................................................... ................. 8.
9. Net Value of Estate (Subtract line 8 from line 7)... ................. .................. 9.
If line 9;s greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II.
PART 11- CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income
Tax Returns for decedent and spouse.)
Income: I. TAX YEAR, 19 2. TAX YEAR, 19 3. TAX YEAR, 19
a. Spouse.. 10. 2a. 3a.
b. Decedent ................... lb. 2b. 3b.
c. Joint. Ie. 20. 3c.
d. Tax Exempt Income. ... Id. 2d. 3d.
e. Other Income not
listed above. 1e. 2e. 3e.
I. Tatal. .......... If. 21. .. 31.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(If)
+ 121)
+ (31)
=
1+ 3)
4b. Average Joint Exemption Income ............ ........................ ............... ....................... =
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
ESTATES
I.
Insert amount of taxable transfers to spouse or S 1 00,000, whichever is less...
1
2.
H -
3.
H_.
4.
5.
2.
3.
Multiply by credit percentage (see instructions) ............. ................
This is the amount of the Resident Spousal Poverty Credit. Include this figure
in fhe 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.
4.
5.
REV.1649 EX. (1-97)
.
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Do not complete this schedule unle.s the estate i. making the election to tax asset. 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 must be filed for each trust.
This election applies to the Trust (marital, residual 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 similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement Is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be inciuded in the election to have such trust or
similar property treated as a taxable transfer in this estate. II 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 Schedule O. The denominator is equal to the total value 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
survivin souse under a Section 9113 A trust or similar arran ement.
DESCRIPTION VALUE
Part A Total $
PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made.
DESCRIPTION VALUE
Part B Total $
(If more space is needed, insert additional sheets of the same size)