HomeMy WebLinkAbout02-06-06 (2)
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FOR DATES OF DEATH AnER 12131/91 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED 0
FILE NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.0601
DECEDENT'S NAME (LAST, fiRST, AND MIDDLE INITIAL)
f\bWE" l-r (V( ~I 6" 6.
SOCIAL SECURITY NUMBER DATE OF DEATH
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/IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST AND MIDDLE INITIAL)
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04.
06.
65
YEAR
OG70
NUMBER
J-l
COUNTY CODE
DECEDENT'S COMPLETE ADDRESS
~.s- t<jt;SLAN 'P (Z" AIr: 'TO (, /
M e-HAV I Cs. e>J~ of It- 1705>'":5
Count Cltft f;1.::"~ I)
AMOUNT RECEIVED (SEE INSTRUCTIONS)
DATE OF BIRTH
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o 40. Future Interest Compromise
(for dotes of death after 12.12.82)
o 7. Decedent Maintained 0 living Trust
(Attach copy of Trust)
o 3. Remainder Return
(for dotes of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_8. Total Number of Safe Deposit Boxes
limited Estate
o 2. Supplemental Return
Original Return
Decedent Died Testate
(Attach copy of Will)
'AttCORRES
NAME J1 J a
tt-UJl:'rzi 5/
TELEPHONE NUMBER
7/
,4 TTht<.fl E:=-
1. Real Estate (Schedule Al
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages and Notes Receivable (Schedule D)
5. Cash, Bonk Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule Fl
7. Transfers (Schedule G) (Schedule Ll
8 . Total Gross Assets (total lines 1-71
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H)
10. Debts, Mortgage liabilities, liens (Schedule I)
11. Total Deductions (total lines 9 & 10)
Net Value of Estate (line 8 minus line 11)
Charitable and Governmental Bequests (Schedule J)
Net Value Subject to Tax (line 12 minus line 13)
Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Schedule K or Schedule M.)
Amount of line 14 taxable at 6% rote
(Include values from Schedule K or Schedule M.)
Amount of Line 14 taxable at 15% rote
(Include values from Schedule K or Schedule M.)
Principal tax due (Add tax from Lines 15, 16 and 17.1
Credits Spousal Poverty Credit Prior Payments
+
(1 )
(2 )
(3 )
(4 )
(5 )
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(10)
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(11 )
(12)
(13)
(14)
(15)
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(16)
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(17)
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x .15 =
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(181
Discount
Interest
+
(19)
(20)
If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
110
Check here if you ore requesting 0 refund of your overpayment.
If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21 A.
8. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE.
Make Check Payable to: Regi.ter of Will., Agent
(211
(21A)
(21 B)
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!-l,:,der penalties of perjury, I declare that I have examine this return, including accompanying schedules and .statements, and to the best of my knowledge and belief,
It IS true, correct and complete. I declare that 011 real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on 011 information of which preparer has any knowledge.
SIG~AT E OF PERSON RESPONSIB OR FILlN ET ADDRESS DATE J J
. /~~~~
DATE '
c
Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
. 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
. 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
. 1% (.01) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
. Spousal transfers occurring on or after 1/1198 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (,;) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
b. retain the right to designate who shall use the property transferred or its income, ...............
a. retain the use or income of the property transferred, .......................................................
c. retain a reversionary interest; or ........ ............ .... ......... ...... ... ....... ............. .......... .... .......
I'
d. receive the promise for life of either payments, benefits or care? .......................................
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2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration? If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration?............................................ ......................................................
3. Did decedent own an 'in trust for'. bank account at his or her deatM......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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REY.1502 EX+ (12-85) * I
COMMONWEAL;; OF PENNSYLVANIA L
INHERITANCE TAX RETURN
~_~E~T~~____
ESTATE OF M 0 Q... I I
. Af-{~ C). (I~\).;{-;.(T
SCHEDULE A
REAL ESTATE
FILE NUMBER "1 ;-
d- ( - (J 5 .- 067 {)
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which 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 hCJVing~easonable knowledge of the relevant facts.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
tJ {j (U~
-~-----
_ __~TAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
$ ()
, \
REV.1503 EX+ (4-86)
~~
SCHEDULE B
STOCKS AND BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
fvlAKtG' ~.
t+61Jcll
FILE NUMBER
;J-( -O<{.- 0 b 70
ESTATE OF
(All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
PN~ I N'vnrn~ IVU. D2-'S'/3t:t t 33
q; D7 2-
~A
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of some size.)
$
I .
Rl'I.1507 EX.. (1.88)
~~~~
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
Please Print or Ty e
FILE NUMBER
d-I- O~ - c> b 70
ESTATE OF
fVlMf~
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{5,
H-t;1UEJ/
(All property jolntly_ned wi", tM Right o' Survlwnhlp must b. dllclOMd Of! SCheduM f.)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
It} J;J ~
TOTAL (Also enter on line 4, Recapitulation) $
o
(If mont space is needed, insert additional sh..ts of same s;ze.)
,1
REY-1508 EX + 12-87)
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SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
:L-( - o~ -00,70
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (vi Ii ~ It: 6 ,
i+6UJt?1I
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER
( I
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tf-.
S,
b.
7.
%,
~.
(0 .
DESCRIPTION
VALUE AT
DATE OF DEATH
SX-J Se::L. C. K
i {lJ r- ~l?..k~ r
:I")... 'f
:3
-..JOlt;\) .5 H-Vf fel JJS; - f2k--y::JtJ '0
U/J (rt:--() /tI-1 t::-14 elt;U 1- tJ $u f# eG UJ. ,- (Zc IPv tJ \)
i-t. (tJ)/::;1<.1'I M uTI) frL - ~(.r,-r./IvP
P;V c- e.. t< Aec- r: N U. s'V -ot717 ,- f 1'12-
f of. F
&1V~L,ty
Ct4-S-H-
tD
361
(
:2l <1 ~1
'f10
d
to (
TOTAL (Also enter on line 5, Recapitulation) S
4 34/
,
(Attach additional aY2" x 11" sheets if more space is needed.)
REV.1509 EX + (12.881
'*
SCHEDULE F
JOINTL Y .OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
f1I1K(~
61
H ElV~ r
FILE NUMBER
:J.-( -O~ - 66'70
Joint tenant(s):
NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
IV () "J[
B.
C.
Jointly-owned property:
LETTER DATE
ITEM FOR TOT AL VALUE DECD'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
, . ;J L.)fJE
TOTAL (Also enter on line 6, Recapitulation) S
(If more space is needed insert additional sheets of same size)
REv-ISIO EX+ (2-87)
'*'
SCHEDULE G
TRANSFERS
COMMONWEALTH OF PENNSYLVANIA
INHII"ANCE fAX IrTUIN
IESIDENT DECEDlNT
PLEASE PRINT OR TYPE
ESTATE OF
FILE NUMBER
f1IA,tft;
r."
~.
t+~ {;I'
cJ./-O)'-()670
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES
ITEM I DESCRIPTION OF PROPERTY TOTAL VALUE DECO. DOLLAR VALUE
EXCLUSION % OF DECEDENT'S
NUMBER 'nclude name of the trons(er.., their relationship to decedent, date of transfer. OF ASSET lNT._ INTEREST
jJlJAJG I
I
I
i
I
i
I
I
!
I
I
I
I
I
I
I I
I
I
I
TOTAL (Also .nter on line 7, Recapitulation) S
IIf more space is need.d, insert additional sheeh o( sam. size.)
CJ
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
\ SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
FILE NUMBER
;L I-oS; -0670
REY-J511 EX+ 17-88)
ESTATE OF
ft1Ae{~ f). !-fGUJ~TI
ITEM DESCRIPTION
NUMBER
AMOUNT
A. Funeral Expenses:
l ~2-
1.
B.
Administrative Costs:
1.
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2.
Attorney Fees A ~ 5. HAJ J ~
IOU
3. Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
Relationship
City
4. Probate Fees
C. Miscellaneous Expenses:
1. /-It'"'Prt-f\+ 5~Ji1.-\
2. fA-'A:'""S
3. L.&(y~L fJ IJll6:::-S
4.
5.
6.
7.
8.
State Zip Code
be:.
!L+
c;
113
TOTAL (Also enter on line 9, Recapitulation)
s
'-f tfcf
(If more space is needed, insert additional sheets of same size.)
. 4
,..
REV-1512 EX+ (1-931
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
FILE NUMBER
J../~O)~Ob70
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MArcL~ 6. -f{I:=.1,L/&,1
ITEM
NUMBER
DESCRIPTION
AMOUNT
1. fJ j tJf-
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of some size.)
$
6
.. .
REV-151J EX+ 12-87)
.
COMMONWEALTH OF P~NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
fV1AR-/~
f); HE1J Ell
FilE NUMBER
;2..1-OS~ ~ 06 7 ()
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF ESTATE
A. Taxable Bequests:
1. KA-~,Q8V~ LA8~/~ S( <; [7::'"12- lout
l12-S f~/JJeGfOP ~.
~-Mf' tt-tLL, ~4-- 17011
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1. jJ olJ'C:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) S
(If more space is needed. insert additional sheets of same size)