HomeMy WebLinkAbout05-27-05
REV_15JDEX i6-00',
.. COMMONWEALTH OF
". PENNSYLVANIA
~.. DEPARTMENT OF REVENUE
, DEPT 280601
e-" HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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~tmE YEAR NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
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o 1. QriginalReturn
D 4. limited Estate
o 6. Decedent Died Testate (At",ch copy of Will)
D 9. Litigation Proceeds Received
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FIRM NAME (If Aoplrcable\
TELEPHONE NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a living Trust (AJiach GQPV ()(Trust\
o 10. Spousal Poverty Credit (date of desth between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
a. Total Number of Safe Deposit Boxes
Election to tax under Sec. 9113(A) (Attach Sch 0\
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule H)
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
::) 7. Inter-Vivos Transfefs & Miscellaileous Non-Probate Property
!:: (Schedule G orl)
Q. 8.
<C Total Gross Assets (total lines 1-7)
U 9 Funeral bpenses & Administrative Costs (Schedule H)
W
a:: Debts of Decedent, Mortgage liabilities, & liens (Schedule I)
10.
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
THiS SECTION MUST BE COMPLeTED. AL.L C(JRRESPONOENCE:AJiRI~
NAME COMPLETE MAILING ADDRESS
TEP fQ~
(1) F rJ(J. ~i)
(2)
(3)
(4)
(5)
(6)
(7)
(8) to,DO
(9)
(10)
\
(11)
(12)
(13)
13. Charitable and Governmental Bequests/See 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
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
x.O_ (15)
x .0 (16)
x .12 (17)
x .15 (18)
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
200
Decedent's Complete Address:
STREET ADDRESS
/"0
53
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C)
(2)
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
ZIP /70 S -"
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the lax dUe.
8. Enter the total of Une 5 + 5A. This IS the BALANCE DUE.
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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; or...
d. receive the promise for life 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 nDn~probate property which
contains a beneficiary designation? .
Ves
....0
....0
...0
....0
.......0
o
o
No
18
I
'0
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Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements. and to the best of my knowledge and belief it is true. correct
and complete
Declaration of preparerolherlhan the personal representative is based on all inforrnationofwhich preparerhas any knowledge
SIGNATURE OF PERSON RESP?,NSIB~~~LlNG RETUR~
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ADDRESS ,~~ l
c;9.L)? ?Y; C-lA_<L.I-.5}jJ--- t<-
SIGNATURE OF PREPARER OTHER THAN REPRE ENTATIVE
DATE
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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 is 3%
[72 P.S. 99116 (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. 99116 (a) (1.1) (iill.
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. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to orlor the 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)(I)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiings 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-1502 EX+ (6-98)
. . '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
e1 4 :c
All real property owned solely or a a tenant in common mus e 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 survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
/919
DESCRIPTION
Sf/- VA-tV mt>c"J..e <J.k me-
VALUE AT DATE
OF DEATH
8'00 :.::-
NAp/)
J-Av.si
Q,o.~
TOTAL (Also enter on line 1, Recapitulation) $ (\" () I
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX+ (1-97) f::
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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
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 lor the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $
(I' more space is needed, insert additional sheets 01 'the same size)
REV'~'"97I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C.1
CLOSEL Y.HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
FILE NUMBER
1. Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
State
ProducVService
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting f NonNoting SHARES OUTSTANDING PAR VALUE OWNED BY 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 Yes o No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the 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 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?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or 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.
DYes
o No
10. Was the decedent's stock said?
DYes
o 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-l or C-2 for each interest.
A. Detailed calcutations used in the valuation of the decedent's stock.
B. Complete copies of financiai 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 addressles 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 heid 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.
REV-1506 EX+ {9-OO}
. ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
FILE NUMBER
1. Name of Partnership
Date Business Commenced
Address
Business Reporting Year
City
State
Zip Code
2. Federal Employer 1.0. Number
3. Type of Business
Product/Service
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
5.
~~~~;:,
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
It yes. Cash Surrender Value $ Net proceeds payable $
Owner of the policy
. .. 0 Yes 0 No
9. 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
poor to 12-31-82?
DYes 0 No
If yes. 0 Transfer 0 Sale
Percentage transferred/sold
Consideration $
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales,
1 Q. Was there a written partnership agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
Date
DYes DNa
11. Was the decedent's partnership interest sold?
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.
DYes 0 No
13. Was the decedent related to any of the partners?
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 eM 1 or CM2 for each interest.
. .. 0 Yes 0 No
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+ (1-97) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
FILE NUMBER
All property ioinlly~owned w"h right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
R"'''''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV"09E~'1'9n .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
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-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and barlk 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) $
(If more space is needed, Insert additional sheets of the same size)
",,",,ex.,,,,,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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 1lhrough 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCUJDETHE NAME OFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTA NDTHE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH ACOPiOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLlCABLE1
NUMBER
1.
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additionai sheets of the same size)
REV-1511 EX+ (12-99) .
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. .~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
f(:cA IiK!
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. 7r:;~oiJ
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Represenlative(s)
Social Security Number(s)/EIN Number of Personal Representalive(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)
Claimanl
Street Address
City State _Zip
Relationship of Claimant 10 Decedent
4. Probate Fees 7L/ -0 J
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ '; '! 0 'f 00
~
5 of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets 01 the same size)
REV 1St< E.:<. 1,1Vi ~
. (q~
~~
COMMmiWEi\l TH OF PENNSYl V i\NIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
TOTAL (Also enler on line 10, Recapilulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) ,
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
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, and transfers under
Sec. 9116 (al (1.21]
I.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18, AS APPROPRIATE, ON REV-ISDO COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
I.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-ISOO COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX+ 112-0.
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 lite, joint or successive lite 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 from 5-1-89 to 4-30~99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
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 LIFE TENANT(S) OATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
o Life or o Term of Years
o Life or o Term of Years -
o Life or o Term of Years -
o Life or o Term of Years
o Life or o Term of Years
1. Value of fund from which life estate is payable . . . . .
2. Actuarial factor per appropriate table
Interest table rate - 0 3 1/2% 06% 0 10% 0 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) ....
.$
%
... .$
ANNUITY INTEREST CALCULATION
NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF OEATH ANNUITY IS PAYABLE
o Life or o Term of Years -
o Life or o Term of Years
o Life or o Term of Years
o Life or o 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)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
.... .$
o Monthly (12)
o 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 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 .
It 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 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
RE-V-1644 EX +4 (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
(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 provisions
of Section 714 of the Inheritance and Estate Tax Act 01 1961 or to report the invasion 01 trust principal.
II. Remainder Prepayment:
A. Election to prepay liled with the Register of Wills on (Date)
(attach copy of election)
B. Nomels) of Life T enantls) 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 Stock/Partnership S
4. Mortgages and Notes S
5. Cosh/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 Unindudable Assets S
4. Total from Schedule L-2 S
E. Toto' 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 enteT on Line 7, Recapitulation)
III. Invasion of Corpus:
A. Invasion of corpus
(Month, Day, Yeor)
B. Nome(s) of Lile Tenant(s) Date of Birth Age an date Term of years income
OT Annuitant(s) corpus consumed or annuity is payable
C. Corpus consumed S
D. Remainder factor {see Table I OT Table \I in Instruction Booklet) S
E. Taxable value of corpus consumed (Line C x Line D) S
(Also enter on Line 7, Recapitulation)
REY.16<l5 EX+ (7-85) INHERITANCE TAX
'*'
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 Initial)
II. Item No. Description Value
A. Real Estate (please describe)
Total value of real estale S
(include on Section II, Line C-] on Schedule L)
B. Slacks and Bonds (please list)
Total value of stocks and bonds S
(include on Section II, Line C-2 on Schedule L)
C. Closely Held Slack/Partnership (ollach Schedule C.] and/or C-2)
(please Iisl)
Total value of Closely Held/Partnership S
(include on Section II, Line C-3 on Schedule L)
D. Mortgages and Notes (please list)
T alai value of Mortgages and Noles S
(include on Section II, Line C.4 on Schedule L)
E. Cash and Miscellaneous Personal Property (please list)
Total value of Cash/Misc. Pers. Property S
(include on Section II, Line C-5 on Schedule L)
Ill. TOTAL (Also enter on Section II, Line C-6 on Schedule L) S
(If more space is needed, attach additional BY, " 11 sheets.)
REY.1646 EX+'(3,8.4! INHERITANCE TAX
* SCHEDULE L-2
COMMONWEALTH OF PENNSYlVANIA REMAINDER PREPAYMENT ELECTION
INHERI1ANCE TAX RETURN -CREDITS- FilE NUMBER
RESIDENT DECEDENT
I. Estate of
(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 S
(include an Section II, line 0-1 on Schedule l)
B. Unpaid Bequests payable from assets reported on Schedule l-1 (please list)
Total unpaid bequests S
(include on Section II, line 0-2 on Schedule L)
C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under
I/B" above) that are not included for tax purposes or that do not form Q part
of the trust.
Computation as follows:
Total unincludable assets S
(include on Section II, line 0-3 on Schedule l)
III. TOTAL (Also enter on Section II, line D-J on Schedule lj S
(If more space is needed, attach additional 8% x 11 sheets.)
REV-1647 EX+ (9-00) .
. 'W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
Check Box 4a on Rev-1500 Cover Sheet
ESTATE OF
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 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 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.
0 Unlimited right of withdrawal 0 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 01 Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00% . ... .... .... ..... ..$
(also include as part 01 total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 06%, 04.5% .... .... .... .... .... ... . ..$
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part 01 total shown on Line 17 01 Cover Sheet) ... .. .$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of fotal shown on Line 18 of Cover Sheet) ... . ..$
7. Total value of Future Interest (sum 01 Lines 2 thru 6 must equal Line 1) ..... .... .... ... . ..$
(If more space is needed, insert additional sheets of the same size)
REV.1648EX (1-n) f.
. ,'*
COMMONWEAl1H OF PENN5YlANlA
INHERITANCE TAX DIVISION
ESTATE OF
SCHEDULE N
SPOUSAL POVERTY CREDIT
AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91)
PART I - CALCULATION OF GROSS ESTATE
I FilE NUMBER
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
1. Taxable Assets total from line 8 (cover sheet) ...............................................,....... ............. 1.
2. Insurance Proceeds on life of Decedent ...........
.................................................. 2.
3. Retirement Benefits......
.............. 3.
4. Joint Assets with Spouse
................. 4.
5.
PA Lottery Winnings ...........
............................... 5.
6d.
60. Other Nontaxable Assets: List {Attach schedule if necessory).. 60.
6b.
6e.
6.
SUBTOTAL (lines 60, b, e, d)...
....................... 6.
7.
To101 Gross Assets IAdd I'lnes 1 thru 6)..........................
......................... 7.
8. Total Actual liabilities .................................................. . ................................................ 8.
9. Net Value of Estate (Subtract line 8 from line 7)................................................................ Q.
" line 9 is greater fhan $200,000. STOP. The estate is not eligible fa claim the credit. If not, continue to Part II.
PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income
Tax Returns for decedent and spouse.)
Income: l. TAX YEAR, 19 2. TAX YEAR, 19 3. TAX YEAR, 19
o. Spouse........ ............ 10. 20. 30.
b. Decedent ........ .......... lb. 2b. 3b.
c. Joint. ...... ... .......... .. 1e. 2e. 3e.
d. Tax Exempt Income..... ld. 2d. 3d.
e. Other Income not
listed above. ........ 1.. 2e. 3e.
I. Toto!................... ...... H. 21. .. 31.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(11)
+ (21)
+ (31)
=
(i- 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 nof, continue to Part III.
PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
ESTATES
1. Insert amount of taxable transfers to spouse or S100,OOO, whichever is less.....
1.
2. Multiply by credit percentage (see instructions) ......... ........................... 2.
3. 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. ........................ 3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate............................................................................................,. 4.
5. 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. 5.
REV-T649 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 unless the estate is making the election to tax assets under Section 9113(A) oflhe Inheritance & Estate Tax Act.
If the election applies 10 more than one trust or similar arrangement, a separate form must be filed for each trust
This eleclion applies to the Trust (marital, residual A, B, By-pass, Unrried 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 OJ
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the eieclion to have such Irust or
similar property treated as a taxable transfer in Ihis estate, If less than the entire value of Ihe 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 af 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 0, 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 additionat sheets of the same size)