HomeMy WebLinkAbout11-14-05 (2)
REV.1500 EX 16-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
(AR8~R -.J05tPi-I t+
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FILE NUMBER
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COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
iCfCf -6'1
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NUMBER
782 ?i
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
U 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12.82)
D 7. Decedent Maintained a Living Trust (Attach copy o!Trust)
D 10. Spousal Poverty Credit (date of death betWeen 12.31-91 and 1-1.95)
o 3. Remainder Return (acle of death prior to 12.13.82)
D 5. Federal Estate TQ~: Return Required
8. Total Number of Sak, Deposit Boxes
D 11. Election to tax undl'T Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME. r COMPLETE MAILING ADDRESS
_ \ C 5. H . r-- A R. '3 € R- leG" i.... \)<e,.J € (t C> Le
FIRM NAME (If Applicable)
(:(...:~t('U.ICl(2. W.o5TmJN~r<[.Q. I (YI\)
TELEPHONE NUMBER
10 - 8' 40 ... S,~-72.
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
/S41'100
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o 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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
S 11(P~'12.
(6)
(7)
(9)
1I;311.cr~
702 '85-
(10)
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)
x.O_ (15)
. "
x.O~ (16)
x .12 (17)
x .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
14~,5'1'.09
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
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Decedent's Complete Address:
STREET ADDRESS=? >? (Y) ARC \-\- \) 6t-\ \l t-
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CA~\' 'H l\..\.-
CITY I STATE f/J I ZIP '-'Oll
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount (j'fi)
3. Interest/Penalty if applicable
(1)
G (P '!if:, . ~ '2.-
334.?>'-J
Total Credits ( A + B + C ) (2)
334.3 Lf
r'\ \_"_~_~i.
U. IIllt::It::~l
E. Penalty
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.
I.. 3S2 .4-f)
(5)
(5A)
(56)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(,3SZ.~'?
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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
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
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
No
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EB
[1]
GI
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Ell
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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 dedare 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 complele.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUg:;1F PERSON RESPONSIBLE FOR FILI;~G RETURN
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ADDRESS
ID Go....~EtJ [atilt: c, Lu€.,S'TmJN.5TC(2.. / (Y)YJ
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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DAJE
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ADDRESS
DATE
, F or 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 30/.
[72 P.S. 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. s9116(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. 99116(a)(1)).
The t~y r!Jtc imnnco,; nn the not \I~IIIO nf tr::mcfcre: tn nr fnr tho. lIC:::C nf the rlo("'gncl1t'c c:ihlinnc ic: 1?O/... r7? P.~ ~Q11h(!:I"1 ~\l d cihlinn ic rlefinorl IInrlor ~Q,..tinn Q1n? !:Ie !:In
.REV-1502,EX+ (6-9W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
JO.5E{Jg
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 tl",e relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
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FILE NUMBEFI
'2 O(!)S - 0 ~ 'llff-
ESTATE OF
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1.
352'?
C'p,ror
DESCRIPTION
/Y1 14 R...C- 1..\ \) Q I V E:.-
l..t iLL (f~ 17 0/1
15J.f,100
TOTAL (Also enter on line 1, Recapitulation) $
ISi.-f, '100
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REV-1508 EX+ (6-98)
" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
J 65 E r i+ ~ r F,:\ Q [3 t (2.-
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.
FilE NUMBER
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
Cf-i€'CIc!' j,V6
~CCOJ&ll
S 7 it, .9 Z
TOTAL (Also enter on line 5, Recapitulation) $
S"Io.t:t2--
,REV-1511. EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
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Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAl EXPENSES: u""€Q.RL- 14-0 111 ~. 567.9 f
1. (\'"\ \.( € 0-- S '_ \-HH~.aI € i1- r: /01
C: Am\' H.ILl fp
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:
Attomey Fees L. AWS . S"lA.e\..lCH -..L p,SAeCd'- 7StJ, t>
2. I
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) $ il,"'311. '1&
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REV-1512 E~+ (12-03) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
JOS€ft.-l
FILE NUMBER
ESTATE OF
It r:- (U2 B € (2....
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
7)t~ 5'
~A'""\ t3PClL. d~ J)-...A.lc)(l\P-","'G. "\)---e.PCS'1
7 tJ). .85-
TOTAL (Also enter on line 10, Recapitulation) $
70"2. 85-
REV-1513 Ef<+ (9-00) ..
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIYING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
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LV f 5 T 1n)1/I Si f: Q... {t1l1'> ~ II 58
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411 8D <\(..5 TON 5 I"
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RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
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AMOUNT OR SHARE
OF ESTATE
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REY.1500 COYER SHEET
II NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REY.1500 COVER SHEET $