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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!XJ 1. Original Retum
D 4. Limited Estate
D 6. Decedent Died Testate (Altach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date of death after 12.12.82)
D 7. Decedent Maintained a Living Trust (Altach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
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COuNTYCOiiE -VEAR- - - NUMiiER-
SOCIAL SECURITY NUMBER
1 9 6 - 2 6 - 7 754
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Retum Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AttachSch 0)
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Johnson Lila T.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
08/09/2005 06/24/1935
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
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NAME
Har M. Baturin Es .
FIRM NAME (If Applicable)
BATURIN & BATURIN
TELEPHONE NUMBER
717 234-2427
Harrisbur
COMPLETE MAILING ADDRESS
2604 North Second Street
0.00 X _(15) 0.00
45,698.00 x .045 (16) 2,056.41
0.00 x .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 2,056.41
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. 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)
13. Charitable and Govemmental 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
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. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0.001
0.00 I
0.00 I
0.00 !
53,651.381
0.001
PA 17110
OFFlpAL USE ONt'O
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(8)
53,651.38
6,183.82
1,769.56
(11)
(12)
(13)
7,953.38
45,698.00
0.00
(14)
45,698.00
Decedent's ompl ete ress:
STREET ADDRESS 208 Senate Avenue, Apt 204
CITY I STATE 1 ZIP
Camp Hill, PA 17011
C Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,056.41
102.82
Total Credits ( A + B + C)
(2)
102.82
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
5.
TotallnteresUPenalty (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 (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX. DUE. (5)
A. Enter the interest on the tax due, (5A)
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
0.00
4,
0.00
1,953.59
1,953.59
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 [Xl
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Xl
c. retain a reversionary interest; or ....................................................................................................... 0 [Xl
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 [Xl
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [Xl
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 [Xl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PA 17043
DATE
For dates of death on or after January 1, 1995, the tax rate imposE>
The statute does not exempt a transfer to a surviving spouse from t.
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 chi!
or a stepparent of the child is 0% [72 P,S, ~9116(a)(1 ,2)).
The tax rate imposed on the net value of transfers to or for the use of the a .",Irs lineal beneficiaries is 4.5%, except as noted in 72 P.S, ~9116(1 ,2) [72 P,S, ~9116(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. ~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.
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~ net value of transfers to or for the use of the surviving spouse is 3%
For dates of death on or after July 1, 1994 and before January,
[72 P.S, ~9116 (a) (1.1) (i)).
'for the use of the surviving spouse is 0% [72 P.S, ~9116 (a) (1,1) (ii)),
for disclosure of assets and filing a tax return are still applicable even if
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. ...lIger at death to or for the use of a natural parent, an adoptive parent,
REV-1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Johnson. Lila T.
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 iointlv-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1503 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Johnson. Lila T.
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1504 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP OR
SOLE.PROPRIETORSHIP
ESTATE OF
Johnson. Lila T.
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.
FILE NUMBER
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1505 EX + (6-98)
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SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson. Lila T.
FilE NUMBER
1. Name of Corporation
Address
City
2 Federal Employer 1.0. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
ProducUService
4.
Preferred
$
----_.._~-_._---_._--
$
Common
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ....................................... 0 Yes 0 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 in 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 Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? .................................................0 Yes 0 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-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
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.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX + (9-00)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
Johnson. Lila T.
FILE NUMBER
1 , Name of Partnership
Address
Date Business Commenced
Business Reporting Year
City State
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 $
Zip Code
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 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? .................................. 0 Yes 0 No
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.
13. Was the decedent related to any of the partners? ................................ 0 Yes 0 No
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.
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 + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Johnson. Lila T.
FILE NUMBER
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
N/A
0.00
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson. Lila T.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC Bank 2,406.78
Savings Account #1090294405
2. Commerce Bank 369.60
3. 1996 Subaru Legacy 3,875.00
4. Cash 47,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
53651.38
REV-1509 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Johnson. Lila T.
FilE NUMBER
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B
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JOINTL Y.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 DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. N/A 0.00 O. 0.00
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
'*
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Johnson. Lila T.
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
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH ACOPV OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE
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)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson. Lila T.
ITEM
NUMBER
A.
1.
2.
3.
4.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Musselman Funeral Home & Cremation Services, Inc.
St. John's Lutheran Church
St. John's Lutheran Church (Organist)
Judy Johnson-Ward (Reimbursement for dinner after funeral)
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Judy Johnson-Ward
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 951 Hummel Avenue
City Lemoyne State PA Zip 17043
Year(s) Commission Paid:
AttomeyFees BATURIN & BATURIN
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees Cumberland County Register of Wills Office
Accountanfs Fees
Tax Retum Preparer's Fees
Cumberland County Register of Wills Office (Short Certificates)
Cumberland County Reporter (Legal Advertising)
The Patriot News (Legal Advertising)
Cumberland County Register of Wills Office (Invetory Filing Fee)
Cumberland County Reigster of Wills Office (Family Settlement Agreement Filing Fee)
Cumberland County Reigster of Wills Office (Informal Accounting Filing Fee)
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
3,555.00
400.00
100.00
160.00
0.00
1,609.55
0.00
80.00
28.00
75.00
126.27
15.00
20.00
15.00
6,183.82
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson. Lila T.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Washington County Register of Wills
To change Executrix, due to death of Lila T. Johnson
VALUE AT DATE
OF DEATH
40.00
2. Liberty Checks
Checks for the estate account
11.70
3. Sears Credit Card
520.43
4. Target Credit Card
311 .22
5. Verizon
Final telephone bill
23.44
6. Bon Ton Credit Card
511.90
7. Chase Visa
350.87
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 769.56
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
,Johnson Lila T
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS OncJude outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1. Jay Johnson Lineal 50%
1162 Allison Avenue
Washington, PA 15301
2. Judy Johnson-Ward Lineal 50%
951 Hummel Avenue
Lemoyne, PA 17043
. -
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. N/A 0.00
-
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. N/A 0.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX + (6-98)
.
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev.1500 Cover Sheet
,
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson. Lila T.
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 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
o Ufe or 0 Term of Years
o Ufe or 0 Term of Years
OUfe or OTerm of Years
o Life or OTerm of Years
1. Value of fund from which life estate is payable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest table rate - 0 31/2% 0 6% 0 10% 0 Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) ..........................................
OUfe or OTerm of Years
OUfe or OTerm of Years
OUfe or OTerm of Years
o Life or OTerm 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, Une 2 multiplied by Une 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Annuity Factor (see instructions)
Interest table rate - 0 31/2% 0 6% 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 ............................ $
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 Unes 13, 15, 16 and 17.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX + (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 Iii;:! T
(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 provisi
of Section 714 ofthe 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
(attach copy of election) (Date)
B. Name(s) of Life Tenant(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 $
2. Stocks and Bonds $
3. Closely Held Stock/Partnership $
4. Mortgages and Notes $
5. Cash/Misc. Personal Property $
6. Total from Schedule L-l $
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities $
2. Unpaid Bequests $
3. Value of Unincludable Assets $
4. Total from Schedule L-2 $
E. Total value of trust assets (Line C-6 minus Line 0-4) $
F. Remainder factor (see Table I or Table II in Instruction Booklet)
G. Taxable Remainder value (Line E x Line F) $
(Also enter on Line 7, Recapitulationl
III. Invasion of Corpus:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income
or Annuitant(s) corpus consumed or annuity is payable
C. Corpus consumed $
D. Remainder factor (see Table I or Table II in Instruction booklet) $
E. Taxable value of corpus consumed (Line C x Line D) $
(Also enter on Line 7, Recapitulation)
ons
REV-1645 EX + (3-84) INHERITANCE TAX
SCHEDULE L-l
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -ASSETS- FILE NUMBER
I. Estate of .Inhnsnn Lila T.
(Last Name) (First Name) (Middle Initial)
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 Cash/Misc. Pers. Property $
(include on Section II Line C-S on Schedule l\
III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $
(If more space is needed, attach additional 81/2 x 11 sheets.)
REV-1646 EX + (3-B4) INHERITANCE TAX
'* SCHEDULE L-2
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN -CREDITS- FILE NUMBER
RESIDENT DECEDENT
I. Estate of . Lila T
(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 $
(include on Section II, Line 0-1 on Schedule L)
B. Unpaid Bequests payable from assets reported on Schedule L- 1 (please list)
Total unpaid bequests $
(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
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, Line 0-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line 0-4 on Schedule L) $
(If more space is needed, attach additional 81/2 x 11 sheets.)
'N.'Mm,.
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
Johnson. Lila T.
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.
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 o 6%, o 3%, 00% . . . .... . .. . . . . . . $
(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. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total 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-1648 EX (11-9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION (AVAILABLE FOR DATES OF DEATH 01/01/92 to 12/31/94)
ESTATE OF I FILE NUMBER
Johnson. Lila T. .
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
SCHEDULE N
SPOUSAL POVERTY CREDIT
PART 1- CALCULATION OF GROSS ESTATE
1. Taxable Assets total from line 8 (cover sheet) ......................................................................................
1.
53 651.38
2. Insurance Proceeds on Life of Decedent .............................................................................................. 2.
3. Retirement Benefits ................................................................................................................................ 3.
4. Joint Assets with Spouse ...................................................................................................................... 4.
5. PA Lottery Winnings .............................................................................................................................. 5.
6a. Other Nontaxable Assets: List (Attach schedule if necessary) ..
6a.
6b.
6c.
6d.
6. SUBTOTAL (Lines 6a, b, c, d) .............................................................................................................. 6.
7. Total Gross Assets (Add lines 1 thru 6) ...............................................................................................
7.
53651.38
8. Total Actual Liabilities... ...... ..... ......... ........... ........ ...... ...... .... ..................... ........... ...... ...... ... ...... ... ..........
9. Net Value of Estate (Subtract line 8 from line 7) ...................................................................................
If line 9 is greater than $200 000 - STOP The estate is not eligible to claim the credit If not continue to Part II
8.
9.
53,651.38
PARTlI - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Icome
Tax Return for decedent and spouse.)
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse ............................. 1a. 2a. 3a.
b. Decedent ......................... 1b. 2b. 3b.
c. Joint ................................. 1c. 2c. 3c.
d. Tax Exempt Income ......... 1d. 2d. 3d.
e. Other Income not
listed above ..................... 1e. 2e. 3e.
f. Total................................. If. 2f. 3f.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(1f)
+ (2f)
+ (3f)
(+3)
4b. Average Joint Exemption Income ...............................................................................................................
If line 4(b) is greater then $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part Ill.
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) ....................................................................................
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. .............................................................
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate ........................................................................................................................
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 ..........
2.
3.
4.
5.
''''..".,,~'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS,
ESTATE OF FILE NUMBER
Johnson. Lila T.
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, 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 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 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)
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
2.056.41
Discount:
102.82
Interest Table
I Days Delinquent
I this time period
----- -- I
~~~for~1981 ______+_
11982 i
11983
1984
r
~ 1985
1986
: 1987
j---
11988 through 1991
l 1992
[1993 through 1994 ~__
i 19~5_thiough 1998
_19~~L_____u_______
2()OO __________ ___
2001
,--------------~--~.,._- .
2002 _+
__209~____________i___
__2004 _______~
Year
Balance Due
this year
Interest
this period
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TOTALS
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Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17,1996:
Penalty: _______