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Home My WebLink About07-28-05 R~.1500EX{6~ i). w ,.., ::.::~(I) "",,,, w"" ",Ole ,,"'.... .... .. " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY FILE NUMBER ":). \ - ~ S -- -- INHERITANCE TAX RETURN RESIDENT DECEDENT ,.., z w o z e .. VI w '" '" e " TELEPHONE NUMBER I- Z W o W U W o '\:l'\:l\.\~l.o NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER ~Original Return D 4. Limited Estate ~ecedent Died Testate (Attach copy a/Will) D 9. Litigation Proceeds Received D 2, Supplemental Retum o 4a. Future Interest Compromise (cate of death alter 12-12-82) o 7. Decedent Maintained a Living Trust (Attach 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) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AltachSch0) 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 Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) !;t o Separate Billing Requested ..J ::J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G or l) ii: Total Gross Assets (total Lines 1-7) <( 8. U 9. Funeral Expenses & Administrative Costs (Schedule H) W D:: 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) 3{;~AI9/A~~ ~~ /P#/70// (1) (2) (3) (4) (5) OFFICIAL USE ONLY -, ; if;)) t'f..j'1. 61) ", <: ~':l /;;.) '-....n :~:J ;IFl -C) . <) _:-J .:J 1;-1 __, <..:J -'r"'"") i --il . --1 -- ~-.4 ..',> ;--;-1 C") .(J c-::; :2 o,il , r.~ r~) C:J ~ -, C.') -" ~~ (6) :::5 ~-~ 01 (7) (8) l/d Y"-3 f.OD , (9) (10) (11) (12) (13) o lid: '1','3 y. CJO 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) 'I;), ~3 Y. 02> , (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < I-' ::J 0.. :i! o U ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1 .2) ?I~.. 1/,3'X 0 /,) 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 collaterai rate 19. Tax Due ,.0_ (15) o '.0_ (16) , .12 (17) , .15 (18) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (19) D 20.0 Decedent's Complete Address: I=m~_ CITY I STATE I ZIP I Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C ) (2) 3. InteresUPenally if applicable D. Interest E. Penalty TotallnteresUPenally ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Une 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 uu. D 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. 1. Did decedent make a transfer and: Yes 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... ................................... ................................... .............................. ............... D 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? ................................ ................................ ....................... .................... 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? .................................... .................................... ........................... No D D D D D D Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaralion of pre parer other than the personal represenlative is based on all information of which preparer has any k nowledge. FILING RETURIil' DATE 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. 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) (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. 99116(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. 99116(1.2) [72 P.S. ~9116(a)(I)]. 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)]. 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 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 survivorship 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-l503e-x+(l-97) '* 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 1. J- ~ t{ DESCRIPTION /f'f-P ~ frt--P It '1-;9 ~ O/06f166rJP /1 ()// 3t;ft,~ ~ 1/1/ {) 101 () f/ f "7 !;J-O-S- /33~ TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ..3 ~..3rr 3. 00 .5"7;'. 0'0 J /CJ-VtJ1J / 3/ 93h-crJ REV~15p4 EX+ (1~97. 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 for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER ,. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 3. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) .-REV'~.I"". 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 1.0. Number 3. Type of Business State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year State ~p Code 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 all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? D Yes D No If yes, Position Annual Saiary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? D Yes D No if yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? DYes D 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? D Yes D No If yes, D Transfer D Sale Number of Shares Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. Consideration $ Date 9. Was there a written shareholders agreement in effect at the time of the decedenfs death? If yes, provide a copy of the agreement. D Yes D No 10. Was the decedent's stock sod? DYes D No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? DYes D 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? D Yes D 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 decedenfs stock. S. Complete copies of financial statements or Federal Corporate Income Tax retums (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 benef~s 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+ (9-0. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FilE NUMBER 1. Name of Partnership Address Date Business Commenced Business Reporting Year City State Zip Code 2. Federal Employer 1.0. Number 3. Type of Business ProductlService 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? .. _ . . . . . . . . . . . . . . . . _ . . . . . . . _ . . . .. 0 Yes 0 No 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 If yes, Cash Surrender Value $ Net proceeds payable $ 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 the date of death was prior to 12-31-82? DYes ONo If yes, 0 Transfer 0 Sale Percentage transferred/sold Consideration $ Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. Date 10. Was there a written partnership agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .. _ . . . . . _ . . . . . . . . . . . If yes, provide a copy of the agreement of sale, etc. DYes ONo DYes ONo 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. 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 C-1 or C-2 for each interest. ............................... DYes ONo 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-15q7 EX+ (1-97) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER All property jointiy-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 4, Recapitulation) $ (It more space is needed, insert additional sheets of the same size) """""'.'''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 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. 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) REV1"~'.{1"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF FILE NUMBER K an ..set was made joint within one year of the decedenfs date of death, K must be reported on Schedule G. SURVlVING JOINT TENANT(S) NAME AODRESS RELATIONSHIP TO OECEDENT A. B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name offinancial institution and balk account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deedfori~n{Jy-heldl9llestate. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A TOTAL (Also enteron line 6, Recapitulation) $ .. (If more space is needed, Insert additional sheets of the same Size) ."V"'~".I''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY ESTATE OF FILE NUMBER This schedule must be completed and filed it 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 ~E OF THE TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND THE DATE Of TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACHACOPVOFTHEDEEDFORREAlESTATE. VALUE OF ASSET INTEREST IFAP~.ICABLE\ NUMBER 1. TOTAL (Also enter on line 7, Recapitulation) $ .. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . .C}"jt& . ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 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 Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV.1512E;(.(1.971~. >. . ~ COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FilE NUMBER Include unreimbul'$ed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) REV-1513 EX+ (9-00) . * COMMONWE.ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(SJ RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (aJ (1.2)] 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 $ (11 more space is needed. insert additional sheets of the same size) REV-151.4 EX+ (12-03) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV-l SOO Cover Sheet ESTATE OF FILE NUMBER 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 from 5-1-89 to 4-30-99, and in Aleph Volume for dates ot 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 NAIIE(S)OF LifE TENANT(S) DATE OF BfRTH NEAREST AGE AT TEAIIO~ YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE o Life or o Term of Years o Lite 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 - 031/2% 06% 010% 0 Variable Rate 3. Value ot life estate (Line 1 multiplied by Line 2) ..... % . ..$ ANNUITY fNTEREST CALCULATION NAIIE(S) OF LIFE ANNUITAHt(S) DATE OF BIRTH NEAAESTAGEAT TERIIOF YEARS DATE OF PEATlI MtlUITY IS PA'IABLE o Life or o Term of Years o Life or o Term of Years o Lite 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 Sf-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 - 0 3 1/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions) .. . . , . . . . . . . . . . . . . . . . . . . . . 7, Value of annuity - Ii 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 and 15 through 18. (If more space )s needed. insert additional sheets of the same size) REV-l64A EX+ 13-84) INHERITANCE TAX ~11b SCHEDULE HLH COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE lAX RElURN RESIDENT DECEDENT OF TRUST PRINCIPAL FilE NUMBER I. Estate of 'last Name) (First Name) (Middle Initial) This scheclule is oppropriote only for estates of c1ecedents 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 reportlhe invasion of trust principal. II. Remainder Prepayment: A. Election to prepay filed with the Register of Wills on (Date) (attach copy of election) 8. Name(s} of Life T en antIs} Date of 8irth Age on date Term of years income or Annuitant[s) of election or annuity is payable e. Assets: Complete Schedule l- 1 1. Real Estate 5 2. Stocks and Bonds S 3. Closely Held Stock/Partnership S 4. Mortgages and Notes S 5. Cash/Misc. Personal Property S 6. Total from Schedule 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 0-4) S -;;- F. Remainder factor [see Table I or Table II in Instruction 800klet) G. Taxable Remainder value [Line E x line F) S IAlso enter on line 7, Recapitulation) III. Invasion of Corpus: A. I nvasion of corpus (Month, Day, Year) 8. Namels} of life Tenant(s) Date of Birth Age on date Term of years income or Annuitant[s) corpus consumed or annuity is payable e. 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 0) S (Also enter on line 7, Recapitulation) REV.1645 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 Namel (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) Total value 01 real estate S (include an Section II, line C.l an Schedule l) B. Stocks and Bonds (please list) Total value 01 stocks and bonds S (include on Section II, line C-2 an Schedule l) C. Closely Held Stock/Partnership (attach Schedule C-l and/or C-2) (please list) Total value 01 Closely Held/Partnership S iinclude on Section II, line C-3 on Schedule l) D. Mortgages and Notes (please list) Total value 01 Mortgages and Notes S (include on Section II, line C-4 on Schedule l) E. Cash and Miscellaneous Personal Property (please list) Total value 01 Cash/Misc. Pers. Property S (include on Section II, Line C-5 an Schedule l) III. TOTAL (Also enter on Section II, line C-6 on Schedule l) S (II more space is needed, attach additional 8Y, x 11 sheets.) REV-1646 EX+ (3-84) INHERITANCE TAX * SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of {Last Name} (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid liabilities Claimed against Original Estate, and payable fram assets reparted an Schedule L- 1 (please list) T otol unpaid liabilities S (include on Section II, Line D-l on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L- 1 (please list) T olal unpaid bequests S (include on Section II, line D-2 on Schedule L) C. Value of assets reported on Schedule L-l (other than unpaid bequests listed under liB" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets S (include on Section II, Line D.3 on Schedule L) III. TOTAL (Also enter on Section II, line D-4 on Schedule Ll S (If more space is needed, attach additional BY, x 11 sheets.) REV-164? EX+ (9-00) . 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 Oecember 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. D Will D Trust D 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. D Unlimited right of withdrawal D 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 0 6%. 0 3%. 000/0................ .. ... .$ (also include as part of 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. Vaiue of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ..... .$ 6. Value 01 Line 1 taxable al collaleral rale (15%) (also include as part of lotal shown on Line 18 of Cover Sheet) ..... .$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................... .$ (If more space is needed, insert additional sheets of the same size) REV~16'. EX Il~921 .. COMMONWEALTH OF PENNSYlANIA INHERITANCE TAX DIVISION ESTATE OF SCHEDULE N SPOUSAL POVERTY CREDIT AVAILABLE FOR DECEDENTS DYING AFTER 12131191 PART I - CALCULATION OF GROSS ESTATE I FILE NUMBER This schedule must be completed and Filed jf you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) ..................................h................................ 1. 2. Insurance Proceeds on Life of Decedent ................................._.......................................... 2. 3. Retirement Benefits...... ....... .._,. .......... ...., ..,...... .... ......... .........___...... _,. ,...... .............. ..-.. ... 3. 4. Joint Assets with Spouse ....................h........................................................................... 4. 5. PA loHery Winnings .............................__....................,.................................................. 5. 6d. 6a. Other Nontaxable Assets: list (Attach schedule if necessary).. ba. 6b~ 6c. 6. SUBTOTAL ILines 60, b, c, d) ........~~...........~~.................~...~.....~~~.................~~.......~~~....... 6~ 7. Total Gross Assets (Add lines 1 thru 6).~...~~~......~.....~....~~~.......~~.........................~~.......~....~ 7. 8. Total Actual liabilities .................................................................................................... 8. 9~ Net Value 01 Estate (Subtract line 8 Irom line 71..~~..~........~.....~~......~~....~.......~.....~~~......~....~ 9~ If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Parlll. PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax Returns for decedent and spouse. ) Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse...................... 10. 20. 30. b. Decedent ................... lb~ 2b. 3b. c. Joint .......................... lc. 2c. 3c~ d. Tax Exempt Income..... ld. 2d~ 3d~ e. Other Income not listed above ........... Ie. 2e. 3e. I. Totol.~...~.~.....~..~~........ 11. 21. 31. 4. Average Joint Exemption Income Calculation 40. Add Joint Exemption Income from above: 111) + (21) + (31) = (i- 3) 4b. Average Joint Exemption Income ..................................................................................... = If line A(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 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.......................... 1. 2. Multiply by credit percentage (see instructions) .................................................................. 2. 3. This is the amount of the Resident Sp'ousol 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 Clnd enter the totol here. This is the omount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. 5. ",,~,~m'I'~O", . 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) of 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, Vnmed 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 percenlage) 10 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 simiiar 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 survivina soouse under a Section 9113 (AI trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the descriotion and value of all interests included in Part A for which the Section 9113 (AI election to tax is beina made. DESCRIPTlON V{l.lUE Part B Total $ (If more space is needed, Insert additional sheets of the same size)