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HomeMy WebLinkAbout11-07-05 REV-ljOO EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY F~rM~E~r l) Jt2- COUNTY CODE YEAR 0 ~M8ER l DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z Kerr, Beverly Kay 531 18 3891 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 04 3 0 05 01 26 18 REGISTER OF WILLS U . W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C UJ [Xl t Original Return 0 2. Supplemental Return 0 3. Remainder Return (dale of death prior to 12-13-82) ~ !;( en 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required 0 ~ ~ UJ c- o I 0 0 0 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a Living Trust (Altach copy of TrLSt) 8. Total Number of Safe Deposit Boxes 00:: -' - c- oo c- D 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 0 11. Election to tax under Sec. 9113(A) (Attach Sch 0) <( f- t,",I$..$I!;CtIONM~$t.a~Cor..tpl;.I:1'EOW..~l;...C()RR.FfSF'O""OFfNCE"""'PC()""FlO~IAl;.tA)(INF()RMAtl()IIl.$~l;.p.'al;.PIR~C1~P'tQ: z NAME COMPLETE MAILING ADDRESS UJ 0 Frank H Kelly, EA Frank H. Ke 11 y , EA z 0 c- FIRM NAME (If Applicable) c/o Kelly Finanicial Services Inc en Kelly Financial Services Inc , UJ , . 0:: 4 00 Bridge Street Suite #4 0:: TELEPHONE NUMBER , 0 New Cumberland, PA 17070 0 717 774 7536 1. Real Estate (Schedule A) (1) 0 00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 336 , 781 00 " 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 . 00 '.. 4. Mortgages & Notes Receivable (Schedule D) (4) 0 00 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 151 , 706 . 00 , Z (Schedule E) - -. 0 6. Jointly Owned Property (Schedule F) (6) 0 00 ~ 0 Separate Billing Requested \ .- - ::> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0 00 (~ I- (Schedule G or L) v. c: 8. Total Gross Assets (total Lines 1 - 7) (8) 488 487 00 <C , . U 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 9 64 7 00 W , . c:: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 828 00 , . 11. Total Deductions (total Lines 9 & 10) (11) 11 , 475 00 12. Net Value of Estate (Line 8 minus Line 11) (12) 477 , 012 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 0 00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 477 , 012 . 00 SEE INSTRUCTIONS FOR APPLICABLE RATES Z 0 15. Amount of Line 14 taxable at the spousal tax 477 012 .0 45 ~ rate, or transfers under Sec. 9116 (a)(1.2) , X (15) 21 , 465 54 ~ 16. Amount of Line 14 taxable at lineal rate X 0_ (16) 0 00 ::> Q. 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0 00 :E 0 18. Amount of Line 14 taxable at collateral rate X .15 (18)___ 0 00 U g 19. Tax Due (19) 21 , 465 54 20. [Xl I CHI8CK HI8~l:1:I~Y()LlAR~REk.WES;flN~ AREITIJ,."P.QF..AI)IQVI8RPAYNiJ;NTI STF PA42021F.1 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE AND RECHECK MATH < < - Docedent's Complete Address: STREET ADDRESS 37 Oakwood Ave CITY h' ~q I STATE PA I ZIP 1 7 055 Mec anlcsur Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 21,465.54 27,000. 1,056.04 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 28,056.04 Total Interest/Penalty (0 + 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. 6,590.50 0.00 (SA) 8. Enter the total of Line 5 + SA. This is the BAlANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 PLEASE ANSWER THE FOLLOVIIING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes o o o o o o contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [XJ 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 peljury, 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. D of preparer other than the personal representative is based on all information of which preparer has any knowledge. GNA RE OF PERSO ESPO LE FOR FI N No [XJ [Xl [XJ [Xl [XJ [XJ /1 DATE __ -- tflc) PA 17055 DATE ()~ Street, Suite #4, New Cumberland, PA 17070 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. ~9116 (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 PS. ~9116 (a) (1.1) (ii)]. 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 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. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 PS. ~9116(1.2)[72 PS. ~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 PS. ~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. STFPA42021F.2 - RIiV-1502 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Beverl Ka Kerr 21.05.0477 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 None STFPA42021F.3 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 - R-i'V-1503 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Beverly Kay Kerr All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION FILE NUMBER 21.05.0477 1. 2. 3. Merrill Lynch - IRA Account Weyerhauser Co - 478 shares Metlife - 178 Shares VALUE AT DATE OF DEATH 317,645 12,212 6,924 STF PA42021FA TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 336,781.00 - R.'iV-1504 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporatiorv'partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None STF PA42021F.5 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 - R/jV-1505 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 1. Name of Corporation None Address City 2. Federal Employer 1.0. Number 3. Type of Business Zip Code State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year State Product/Service 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK Common $ Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? If yes, Position 6. Was the Corporation indebted to the decedent? 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 $ Dyes DNo Annual Salary $ Time Devoted to Business DYes DNo Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82? Dyes DNo If yes, DTransfer Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. o Sale Number of Shares Consideration $ Date 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. DYes DNo 10. Was the decedent's stock sold? Dyes DNo If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? DYes DNo 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? DYes DNo 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 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 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. STF PA42021F.6 RIiV-1506 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 1. Name of Partnership None Address City 2. Federal Employer 1.0. Number 3. Type of Business Date Business Commenced Business Reporting Year State Zip Code ProducUService 4. Decedent was a D General D Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? DYes DNo If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? Dyes D 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 DNo If yes, DTransfer DSale Percentage transferred/sold Consideration $ Date Transferee or Purchaser 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? If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? DYes DNo If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? DYes DNo Dyes DNo 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? DYes DNo If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? Dyes DNo 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 retums (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. STFPA42021F.7 R"V-1507 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None STF PA42021F.8 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 Rf<V-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2. 3. 4. 5. Sovereign Bank Household Furnishings- Goodwill Value Used Watch - Goodwill Value Used Various Costume Jewelry - Goodwill Value Used Clothing - Goodwill Value Used 149,531 1,825 25 150 175 STFPA42021F.9 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 151,706.00 R:;:V-1509 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY -OWNED PROPERTY ESTATE OF Beverly Kay Kerr If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21.05.0477 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. None B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE InclLde name of financial instiMion and ball< accolJlt nurrlJer or similar identifying number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly-rekJ real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 0.00 STFPA42021F.10 (If more space is needed, insert additional sheets of the same size) RF<V-1510 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 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 %OF ITEM IM::LUDE THE WlME OF THE TRANSFEREE, Tl-EIR RELATIONSHIP TO DECEDENT AND THE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. None 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on line 7, Recapitulation) $ 0.00 STFPA42021F.11 (If more space is needed, insert additional sheets of the same size) RI;V-1511 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hetrick Funeral Home, Harrisburg, PA 1,750 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Represenlative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (~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 360 5. Accountant's Fees 7,327 6. Tax Return Preparer's Fees 210 7. TOTAL (Also enter on line 9, Recapitulation) $ 9,647.00 (If more space is needed, insert additional sheets of the same size) STF PA42021F.12 RF.:V-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Beverly Kay Kerr FILE NUMBER 21.05.0477 Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6 . 7. 8 . 9. 10. ll. 12. 13. 14. 15. 16. 17. DESCRIPTION AMOUNT PAWC Water Upper Allen Twp. Sewer Fuel Oil Electric Cable Telephone West Shore EMS Pinnacle Dianon Sys Lab PA Gastrological Asoc Physician Rehabilitation Quantum Imaging Associated Cardiologist Digestive Disorder Lehigh Anesthiesa Moffett Heart Group Silver Springs Twp. EMS 37 100 180 65 42 26 592 62 126 98 60 6 5 64 20 250 95 STFPA42021F.13 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,828.00 - RF.V-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BeverlJ Kay Kerr NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Gary Watts 1. 512 East Keller Street Mechanicsburg, PA 17055 FILE NUMBER 21.05 0477 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Son 100% 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) 0.00 STF PA42021 F.14 - R~V-1514 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER N/A Beverly Kay Kerr 21.05.0477 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. D Will D Intervivos Deed of Trust D other l.;Ifl;<I;S'f~TI;.'....'N"J'I;RI;$T.C~LCUI..ATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE D Life or D Term of Years D Life or D Term of Years D Life or D Term of Years 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate - D 3 1/2% D 6% D 10% 3. Value of life estate (Line 1 multiplied by Line 2) D Life or D Term of Years $ D Variable Rate % il"ll Amu" i.... i iH ..... Hi NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE D Life or D Term of Years D Life or D Term of Years D Life or D Term of Years D Life or D Term of Years 1. Value of fund from which annuity is payable 2. Check appropriate block below and enter corresponding (number) Frequency of payout - D Weekly (52) D Bi-weekly (26) D Quarterly (4) D Semi-annually (2) D Annually (1) 3. Amount of payout per period 4. Aggregate annual payment, Line 2 muniplied by Line 3 5. Annuity Factor (see instructions) Interest table rate D 3 1/2% D 6% D 10% 6. Adjustment Factor (see instructions) 7. Value of annuity -If using 3 1/2%, 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 $ D Monthly (12) D Other ( ) $ 0.00 D Variable Rate % $ $ 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, 15,16 and 17. STFPA42021F.15 (If more space is needed, insert additional sheets of the same size) Rf:V-1647 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 Beverly Kay Kerr 21.05.0477 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 l.N/A 2. 3. 4. 5. It For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal m. 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 06%, 03%, 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 STFPA42021F.16 (If more space is needed, insert additional sheets of the same size) RIiV-1649 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Beverly Kay Kerr 21.05.0477 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 surviving spouse under a Section 9113 (A) trust or similar arrangement. ~~~~ m~ N/A Part A Total $ 0.00 PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE STFPA42021F.17 Part B Total $ (If more space is needed, insert additional sheets of the same size) 0.00