HomeMy WebLinkAbout01-09-06
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REV-1500
FILE NUMBER
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COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
4, I -.:L $?
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NUMBER
3~8{
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dale of dealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
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0.00
0.00
0.00
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NAME
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COMPLETE MAILING ADDRESS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DEC7fENT'S NtME (LAST, FIRST, AND MIDDLE INITIAL) _
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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)
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(14)
TELEPHONE NUMBER
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(8)
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(11)
(12)
(13)
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R 1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Allach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (cale of dealh after 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach copy ofTrusl)
D 10. Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1-95)
0.00
0.00
0.00
0.00
0.00
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E. S+i {t ie 1
FIRM NAME (If Applicable)
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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)
o 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 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 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 0.00
rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15)
16. Amount of Line 14 taxable at lineal rate 0.00 x .0_ (16)
17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
19. Tax Due (19)
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS <30;2.. Coo lid
5 +ree.t
CITY
N Q.W C\.L II\A.
STATE P A
ZIP l ,0-7 0
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
o . 0. C>
Total Credits (A + B + C ) (2)
C).C> L)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
0.0 ()
0.00
C).OO
0.00
D.OO
Total Interest/Penalty ( 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)
5. 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.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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 preparer has any knowledge. .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. ~.idr~~a~~~~:tu::k:r ~n::~~e~f~~~:property transferred;.......................................................................................... 0 &-
b. retain the right to designate who shall use the property transferred or its income; ........................................... 0 521
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 j((
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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. S9116 (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. S9116 (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. 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. S9116(1.2) [72 P.S. S9116(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. S9116(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.
-, REV-1~EX:.11-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
tzober+ E
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF '
AtJ'\d r--ewS
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
NUMBER
1.
DESCRIPTION
lA V\. Cet S ~ e ~ Go ..s-f 1/- ~ W\ .e,,\ ..\- G ~.e c k <;. .+o~""
SoC\ Gd Secv,,~~..\.-y D\ Set ':Jll',.+y t;eir\e {", +- S
Ct V\ ~ So C '( vd Se c LJ t- (.i, R.e..\-\ r -C i-V'--e (,~ '-\-
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VALUE AT DATE
OF DEATH
i~ 0,7..00
TOTAL (Also enter on line 5, Recapitulation) $ \ ~ Q'7 \ 00
(If more space is needed, insert additional sheets of the same size)
-RE~-1511 EX+ (12-99) _
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF d
AV\ /(~W S I
Rob.er+
FILE NUMBER
c
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
B.
1.
DESCRIPTION
AMOUNT
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ADMINISTRATIVE COSTS:
Ib~q(S~
1: V\C .
$ Vr-€rv \ sur
Personal Representative's Commissions
O.DO
Name 01 Personal Representative(s)
Social Security Number(s)/EIN Number 01 Personal Representative(s)
Street Address
City
State _ Zip
3.
2. Attorney Fees
Year(s) Commission Paid:
4.
5.
6.
7.
Family Exemption: (II decedent's address is not the same as claimant's, attach explanation)
0,.00
0.00
Claimant
Street Address
City
State _ Zip
Relationship 01 Claimant to Decedent
Probate Fees
54.00
0,00
0.00
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation) $ l7 L/3. 5 (
(II more space is needed, insert additional sheets 01 the same size)