HomeMy WebLinkAbout11-02-05
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REV.'i500 E.x :6-001
'*"" COMMONWEALTH OF
PENNSYLVANIA
,~. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
FILE NUMBER
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COUNTY tooE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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SOCIAL SECURITY NUMBER
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DATE OF DEATH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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r:g 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of WI'I)
D 9. litigation Proceeds Received
F BIRTH (MM-DD-YEAR)
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
D 4a. Future Interest Compromise (cate of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior 1012,13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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:~~O. ALl. CORResPONOENC~ AND~ """lTAA 1N~"A1J1O:N:!.
COMPLETE MAILING AD.DRESS R' I
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FIRM NAME (If Applicable)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Pl'oprietorship
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
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6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-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)
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(1)
(2)
(3)
(4)
(5)
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3'-1935:1. t&, I
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(6)
4jg :21 {, , 9 ~
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(7)
(8)
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(9)
(10)
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(11)
(12)
(13)
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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 113)
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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
20. D
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x.O _ (16)
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x .12 (17)
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x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(19)
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Decedent's Complete Address:
I STREET ADDRESS
CITY
I STATE
I ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
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Total Credits ( A + B + C )
(2)
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3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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(5) ..:rt9, 9' t9 .3. II
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A. Enter the interest on the tax due.
(5A)
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B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5B) -/y' 6"7> 9' [):3 I J
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Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 g
b. retain the right to designate who shall use the property transferred or its income; ........................................... 0 ~
c. retain a reversionary interest; or....................................................................................................................... 0 .g]
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 RI
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 ~
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 schedules and statements, and to the best 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 pre parer has any knowledge.
SIGNATURE OF PERSON RESPONSIB FOR FILING RETURN
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DATE
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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)].
35 P tld ~ 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)].
I oJ; '. ;e from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
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tt--"t;lJ--0 It/?, D 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 use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
__~. v"" fJi:l[ent In common with the decedent, whether by blood or adoption.
'ceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
For dates of a
The statute Q.Q
the surviving sl
For dates of de
The tax rate im
or a stepparent
The tax rate imp
The tax rate im~
individual who he
REV-1 s.o2 ,EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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
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TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
,
REV.1~'<l3 EX. (1.97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Audrey
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
LUe/l-vey'
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DESCRIPTION
lA, .:>. SM /n i:) ;tjp Ai b > (, So '1/ ere I ~ h 'J3 I'HI KJ
-Prvd€.n I,'A L SeCV~ltl'-e '> :r tZA
Ae..c+ ~ f/&::r 100 t,S
VALUE AT DATE
OF DEATH
4J /1/3g.77:2
ITEM
NUMBER
1.
, A 'I J (p 11. )"" 3
3.
VI;Ue.~il bl~ FJ r'I J 5 1.. (l A
Ac-c7 ~ E () ?"l. 'l !J ~ '1
;20 ~ 7i7. 3'
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If.
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ :3'1:J.. g 5' t? i:. I
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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 for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX+ (1-97)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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.
{
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TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX' (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST ATE OF j) tI cI r uJ~~ II' ~ FILE NUMBER
Include the proceeds of litigation a1 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.
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3.
J..J.
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DESCRIPTION
l'IEf) j;;/1d~ Pri/Je.Y1fl'/i-L :J-""e::.IP1~n f-~ AYlYlkifj
A-c-c i f:t E 0 ~ 9~)...5 7 .
fotVT/N,zJJ,1t L G,;:/IJ,;,eA l.. '~e:~.,b o~ PrU"'''.IP\
PD I I (.. 'I ~ i~ L I 5' S I 2 CJ 7
LI'h€t"f7 f'Y7-.;lvpL 7<elMh ()f f-re.rn\v('Y\
PD L. 'c 1 it A o'~ 2-. Z, I ~ t../ SOD t::.D S'
P r V de. V1 ~ , ~ L. C' . ~a...V\c: ~ (\- Lt:<t!l' W\ b L 7 c.
/iCcf -c' /tJOOC> ~~Cjo~
~ J1 I <"", e Y' e ,~n '13A rJ 1<
C it e.c.. k.. , 1"\ I rec-' vIS> V '. I ,
A e.e....i -i<' J lc f:.! I '1 ;to & I z..
Ke ~UA'\&
p '" 0 t1 <'"-
7/7-71.-1. r>-42';-O-9 3~
ovd~".. t,~ L
CA-Sr+ VA- I v ~ I r .r
/l-e...c:.t i:L (p 3 " 0 3 ;).. D :J
II hi. Y/.
,4c..c+ V 8 t9 I 3 V. {p I
Ve.. y'a,D ,J
4cc:t -9
L~ fe 1~~
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fV1'SC
Asse.1:s
efa> t-'" ~ ::,
r-v or 1"\ \ + v...--e
fA;forYl 0 h; / < ''19 ~ t(.t~
(#^bA ?J)O~)
fi",~
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VALUE AT DATE
OF DEATH
R7 - I ":J
:Jtp ,/),..,
)
;;? '1 3 .-? 1
J../lJ;,~O
J ~ 3 .30
I 5;;~' 1::>
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ll.?'-I
l~ o11.~ J
..,IJ 7 \0'
/1 90'l.;;:?9
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'lSl>. ,.'fL'
3 ~S; ,.1,;)
()t.'l
.3 :;"lJ() .
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ t.jf. ct / ~ . 9 f
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REV.l509 EX.. (1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
W.e,4- 1/ ~ tC...
If an asset was made joint within one year of the dece ent's date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. Be- +fr Wf'A vel?-
B.
c.
53 i' ])/~ h I ,eel
rYJ~c~;'" Pj I fJ/1 170 ~~.--
S;< s k r
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. /9f3 53~ ]), e t.. L R-d 113 {)CJD 62>% ~-4> ~C}O
(YJ2C h b J P/1 I~O ~s I J
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TOTAL (Also enter on line 6, Recapitulation) .-~ 00
$..:) ,,b?:;D. ..__
..
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 EX+ (12-99) _
", d~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
/lvclre-v uJe/l-t/eR-
/ Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
/J74Lj/e z..'2. i
/YJe_c_hJ~, A
r:vnerl9 L
.-
,70S- :;
/~n" e
, Itf3'l.090
I
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
/89, tJ."
5. Accountant's Fees
6.
Tax Return Preparer's Fees
7.
7(e~ t. f, 1;9 I-e
fl/~ r~ sJ4L
4f(
3 ::l 6-: ~ (J
TOTAL (Also enter on line 9, Recapitulation) $ '1 t) 5"'/. () GJ
I.lf more space is needed, insert addllional sheets of the same size) I
REV.1512 'Ex + (1-9~)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
~\~
\ Or'
\
\
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
. .
'R~V-1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
1.
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
f3~tfy L. \N'cc..vcr s.:J.t~r yc../(P)SJ~.::>1
S'115 t): chi tfd
Mc-,-k&<i'\~(~bu(~J fA "()~~
NUMBER
I
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 $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPH'28060 1
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WEAVER BETTY
538 DIEHL ROAD
MECHANICSBURG, PA 17055
__nun fold
ESTATE INFORMATION: SSN: 208-28-6858
FILE NUMBER: 2105-0765
DECEDENT NAME: WEA VER AUDREY J
DATE OF PAYMENT: 11/02/2005
POSTMARK DATE: 11/02/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/06/2005
NO. CD 005962
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $50,903.11
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TOTAL AMOUNT PAID:
REMARKS: BETTY WEAVER
CHECK# 112
SEAL
INITIALS: CM
RECEIVED BY:
REGISTER OF WILLS
$50,903.11
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS