HomeMy WebLinkAbout02-17-06
REV. 1500 EX (6.00)
'* COMMONWEAITHOF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I-
Z
W
C
W
o
W
C
w
~
~~~
00.0
woo
J:Q:..J
OD.ID
0.
c(
~ 1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attach copy ofWdl)
D 9. Litigation Proceeds Received
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
'2-1- - 0 ~ 0 3 <-i ~_
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
\~~ - It.l
~ q4 (.,
THIS RETURN MUST BE FILED IN DUPUCA TE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12~2)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13~2)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach 5ch 0)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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 Properly (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly
(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)
z
o
~
-I
::)
l-
ii:
<(
o
w
~
14. Net Value Subject to Tax (Line 12 minus Line 13)
COMPLETE MAILING ADDRESS
~~d/~w (1. S~~&/7 '- "'H()r~lA.t
12. 7 s. /H~/~~ f ~f-I P. O. Box 'i.r
lJ?~ha4le$ ~lA'f PA I ]D~
(1)
(2)
(3)
(4)
(5)
,... ,..)
t':.... .'.
II '-D () I () 0
~-J
(6)
c. ,)
C')
- )
(7)
(9)
(10)
(8)
tlJIO,-/,fJO
I
, I Z- t:J 0, c::> t:J
(11)
(12)
(13)
" ,10'/. ()f)
0,00
(14)
0.0 {)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
o
(/). () l)
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
x .0 _ (15)
x .0 _ (16)
________________________________________________ x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(19)
() , tJ 0
z
o
~
~
::)
Q.
:i
o
o
g
20.0
..;:;.::,.1;j~~il_~L:~2~~~ :.:~"ctlL~~b~.~,.::,..:~.~:~_(j7m.~~~;llimI~..:.;;i!;i,;iiii;;::;iJi;.'..:)i,;il~1i!i;.;;i!;lii1ji;i;:.:/:;;!(;;~~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
REV-15G8 EX+ (6-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FRED M. MAST, JR.
FILE NUMBER
21-05-0340
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
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
Refund from Long Term Care Insurance
$ 1,200.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
1 "lnn nil
.
,"EV-'511 EX+ (12_99)_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
(V1AtJi) (fA. FQ..eD M.
1
FilE NUMBER
21-05-0340
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
L ...."re., l H alS (e.IV\e. hr:;) -
I..A.. r "
3oCJ. 0 c>
B. ADMINISTRATIVE COSTS:
1 . Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Add ress
City
State _ lip
Year(s) Commission Paid:
3.
Attorney Fees /1"1 ~t..W ~ ~;,., (' d i I I9I:i::.orl1el
Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant FrM tt S j\/. MIlAS r-
StreetAddress 780 Ot!Jt It- OVCVJ
City /YI~I. WI 1""- 6W'1
-z,. S-I'. c> 0
2.
3, ~ (!)t? I 0 0
State p 4 Zip
17 D ~S-
Relationship of Claimant to Decedent
S pc) v-.. ~..L-
5.
Probate Fees Rt 1 ; Stt/ ~t """,, ~ I C' ..-. w I ell tJ Cdk1 ~
Accountanfs Fees
~4, t:)(J
4.
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ L./ J J 0 L.I f 0 ~
(If more space is needed, insert additional sheets of the same size)
rC/-l tj iJ E.x, (9-00)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRED M. MAST, JR.
FILE NUMBER
21-05-0340
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 [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
'6 17- b V
FRANCES N. MAST, ~pO LA ~c...
780 OAK OVAL
MECHANICSBURG PA 17055
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
. .
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)