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Home My WebLink About09-26-05 !;EV-,5<J() EX (lk<li COMMONWEAlTH OF PENNSYlVANIA DEPARrMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w o w U w ,.... ~ W I- l<:~lI) oll!l<: wn.o :r;oo oll!-' n.CD 0- << DECEDENT'S NAME (lAST. FIRST. AND MIDDLE INITIAL) a '-:" 1. Original Return o 4. limited Estate o 6. Decedent Died Testate (AlladllXlpy dWl) o 9_ Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (_or_alit.-12.12-821 o 7. Decedent Maintained a living Trust (AlladllXlpyafTrusl) o 10. Spousal Poverty Credit (_of__12-31-91 8I'd 1-1-95) FILE NUMBER ~ L - t2f COlJllY COOE YEAR f2t2-LxJ!:- tu.ll!aR SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILjlS SOCiAl SECURITY NUMBER o 3. Remainder Return (da'.e or _ PIio,:o '2.~3-82) o 5. Federal Estate Tax Return Req~ired 8. Total Number of Safe Deposit Boxes o 11. Eleaion to tax under Sec. 911G(A) (A1tad1 SchO) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA11ON SHOULD BE DIRECTED TO: NAME COMPlETE MAlUNG ADDRESS /-? 11.1 W. K.t.,t.t.E/f 5TRE.t-n NFefl/?/'I/(lSI3t1RG ?/l /~005 ) z o ~ ...J ::> '= a.. <( u w c:: z o ~ r-; ::> c.. :l5 o u ~ I- :z w c z o n. U) w II! II! o U o (1) ".~ tJC.tJ - L~ (2) (3) (4) (5) /J~ It; 7 - 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 & M'JSCeIlaneous Personal Property (Schedule E) 6. Jointly Owned PltlJIerty (Schedule F) o Separate Billing Requested 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Properly (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administnltive Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabir4ies. & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental BequestslSec 9113 Trusts for which an eIeclion to tax has not been made (Schedule J) (6) (7) (9) I~ 'J"3 ~ - (10) ~ 97 f - 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCllONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) ,) 'C~) <":1 (8) ~.:J~/t7- (11) (12) (13) /~ ~C/ - ;l/~ 70~- (14) 16. Amount of Line 14 taxable at tineal rate 4,1/fJ 70r;- ) x .0 _ (15) x .0 ~::r (16) .f ~ ~ 3..2 do x .12 (17) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at coDateral rate x .15 (18) 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ">> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND.RECHECK MATH < < (19) ". ~ ~8.2 d. De~edent's Complete Address: l:~;~~;:~e:::~:EET \ I I sTATEplI I Z1/7Q5:~? (1) .I ~ L/8'-<. d Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditS/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Tolal Credits ( A + B + C ) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty (3) (4) (5) (5A) 4. TolallnteresUPenalty ( D + E ) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ~9/(~~1 & A. Enter the interest on the lax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ~ (56) $" ~ ~ 8 ~ . Make Check Payable to: REGISTER OF WILLS, AGENT 1. Did decedent make a transfer and: Yes a. relain the use or income of the property transferred; .......................................................................................... 0 b. relain the right 10 designate who shall use the property transferred or its income; ............................................ 0 c. relain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either paymenls, 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 conlains a beneficiary designation? ........................................................................................................................ 0 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ~ ~ [2( ~ Q( 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 p~es of peljury, I decIare!hall have exanined lIis I1IUn, incIudng aa:omparl)V1g scheWIes lWId slalemenls, and lo the best of my knowledge and beief.1t is \rue, alfIlld and alInJlIeIe. Detlallltion of prepalBl' oilier than lhe personal representative is based on all information of Yotich preparer has any knowledge. . SIGNATURE OF PERSON RESPO~I;..z FlUNG RETURN ~ DATE A~A_~,,~~u ~. j?~Cq --' fl'/~~"'P"" S~A~JR~.PR~r~1oit~ ~AN ~~~"VE hi ~ /-/ /?N/ ('JS/3t/ K C} /=' /J / 7<:J_~~ ~ DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rale imposed on the net value of transfers 10 or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, lhe tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iill. 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 survMng 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 anA nr vnlllv..... ~. ..__.L .- - or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. TJ~e... 3l(.. 00 The tax rate imposed on the net value at transfers to or for the use of the decedenfs lineal benefi\ ~ \' .1 (c ('1 c.:C The lax rate imposed on the net value of transfers to or for the use of the decedenfs siblings t" C ~ . individual who has at leasl one parent in common with the decedent, whether by blood or adoptior A. P.D 5l". ( (~- ~ . +4-\.--S1 latural paren~ an adoptive parent, i(1.2) [72 P.S. ~9116(a)(1)]. fined, under Section 9102, as an REV-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER PEII~.J. R. 8ISHO~ :/,/.05-00/88 AU real pn>>perty owned solely or as a tenant in common .... be reported at fair marht value, Fair market value Is defined as the price at whIch property would be exchanged between a willing buyer and a wUUng seIleI; nellher being compeUed to buy or sell. both having reasonable Imowledge c:J the relevant facts. Real ptoperty which Is joInIIyoowMd with right of swviwnhIp nust be dilIoIosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. CESCRIPTION lteS/Z)EN(.'E ~O(!ATIIZJ /iT ..t9 &. I<I?.LI.EI? ST/i(ER'T P1EeNRl'llesBUI?~ ?/1 /70~.:::7 ~ ) VALUE AT ClATE OF DEATH "?:t. O(J 0 J !!P TOTAL (Also enter on line 1, Recapitulation) $ (If more space Is naeded, insert additional sheets c:J the same size) 9':< j flOO.OO II REV-15G8 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 1:71:.-IiI~J.. A. /31.51-101=' .;2/-05-00/88 Include the proceeds of litigation and the date the proceeds were received by the estate. All property joInt1y-owned with right of survivorship must be disclosed on Schedule F. ,5 ~. 1, VALUE,AJr DATE DESCRIPTION OF OI1ATH me/J18~Ii'S 1ST f'EPc/?/I.f. eREZJI TUN/ON ., 9f1 ()'O.,t. U PNe sor;o. U REr-UND fROM NEtX/S~/?~E.R 3/..:'/03 ; /f8. ~ ~ -~ " I/'IHE,RIT~NeE ~/(~/11 ~:57~TE (J/ 8#.R8/lArJ 1/.,0, ,~I -- A'lTR /'IS (~J:.) +"//i"/t'J5 REr-QIVJ/ 0' /NStlRNIIICE ~//..1/0S 70. u ,~ r'IIIfEB/lrE d/ /?E/9.1. E5T&TE T/lXES 7.~8{,5 ~91. - ~~ /' ,~ /IVTEI?EST .l?EeE/VED ON AeeOUNT ~tJ. ITEM NUMBER I. /<. 3. 1: TOTAL (Also enter on line 5, Recapitulation) $ I J 7 / ~ ? ~ (If more space is needed, insert additional sheets of the same size) ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER PEARl.. /? 8/fH(J? ~/-05-nn/83 Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION 1. FUNERAL EXPENSES: (///1/(;;:( Ie II M/:/J1tJR //1~.s B. ADMINISTRATIVE COSTS: 1. Personal Represenllllive's Commissions 4. Name of Personal Represenlative(s) Social Security Number(s)IEIN 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) Street Address City fi1Ef'7#I9N/CSI3URC State ~Zip /7c):::F6 Relationship of Claimant to Decedent .5 <:) /\/ "'"".ZJ 191./ a /-/ T Ex Probate Fees 6. Tax Return Preparer's Fees 5. Accountant's Fees 7. 3- f la //. tf,PJ<L.:.>E r) ,R/:~6JU/tfl!Z; I?c?/lIR.~ /lNZJ /11/1INT~/IIt?Ne. T~ ,PR~/.7I:'l?TY rtJ;f .s/lA& ,r'?(,8'</C? /ltt~T/(/1V eOPl/J?/S.5/otV(el7C/CK r5'K/(!/<L-?e I? P,r=='R /f / S# ..<: ~/l/LJ .TClt(/?N"?,(, ~ 19ZJ r If' h" IV 5;C'.E R TOTAL (Also enter on line 9, Recapitulation) $ / / (If more space is needed, insert additional sheets of the same size) AM NT //.6 ~ /00 I I : #2- / /7'tfi ~5(fO ~ I ~ (J 7" ~ - I I , dO .9;/f'ff5 ~ .I .7r! 0 ~ J. e10 34cJ - I ~~cf' 5!.4 dO 9)<0 - ~ REV-1512 EX' (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABllmES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FilE NUMBER /t;E/9/?~ /? 8/S#OP ~-(J~~-OO/8K Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death. Including unreimbursed medical expenses. VAlUE AT DATE OF DEAtTH "/t't'f.' d 'lOts' .P '0 ~.3~47. - #tJ 3/~5 - ITEM NUMBER DESCRIPTION 1. il'lXE5 tI r /.<. / Ties ~ 0/ A. .1.. 3. -$'. 8/.<.~ t/r't?~/?LJE E1.EeT/fIC REP.t.rlC!E SIZ>L7a//T~K ~ TOTAl (Also enter on line 10, Recapitulation) $ t 979 (If more space is needed, insert additional sheels of the same sIzs)