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Home My WebLink About03-08-06 (2) - --1 15056051047 REV-1500 EX (06-05) PA Department of Revenue *& Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number .L j 0 5 0075/ Decedent's Last Name \<i9 qy ()t.f~1 Date of Birth OloOI JOO"5 3 M ( + k Suffix OIO'$jqJq Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ~o..~!\ I. Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS c:::> 2. Supplemental Return c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> 4. Limited Estate c:::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date of death c:::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Day1ime Telephone Number c:::> 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received c:::> Q 8. Total Number of Safe Deposit Boxes c:::> Oj~1 I a.. M Firrn Name (If Applicable) c Diss (\ ~er ~i :, ~ I (\ ~ (' r and ~ First line of address Lj 0 0 S () t.l- i- n ~+ at e. Second line of address ~'Si t\ ~ e (' 1 "'1.'? 7 .:) 'i.~) <oj ( '. REGISTER QFWi!=)...s USE o-&i~ l ((0 D-d I C' City or Post Office t~o...c ~~\I State ZIP Code DATE FILED ~i'::- e. P A 1 o"s .5 Correspondent's e-mail address: =- 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. F R FILING RETURN L Side 1 15056051047 15056051047 --.J pt - --1 15056052048 REV-1500 EX Decedent's Name: Decedent's Social Security Number RECAPITULATION <6(1 <-l4 04S( 1. Real estate (Schedule A). ........................... . . . . . . . . . . . . . . . .. 1. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . " 3. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 2. . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . " 5. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . " 4. . . 6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::> Separate Billing Requested. . . . . . " 7. f4 s SS.34 . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . " 9. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8. . 11. Total Deductions (total Lines 9 & 10)...... . " ..... .... . .... '" . '" '" " 11. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. iI -s '35.3 t.j l./ 7 0.00 . 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. . 5'O&5.3~ 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spOusal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 5~ltS.~~ . 15. 5'61J '$. s4 16. . d l.t :$.q <[ . . d (, ~.CJ <{ c::> . 17. . 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L Side 2 15056052048 15056052048 ....J -- REV-1500 EX Page J Decedent's Complete Address: DECEDENT'S NAME File Number CITY A ZIP il0'5"S Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) (Jt.,<~. gl.l 3. InteresVPenalty if applicable D. Interest E. Penalty Total Credits ( A + 8 + C ) (2) TotallnteresVPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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 (SA) (58) ~l.t S. 9~ 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 00 c. retain a reversionary interest; or.......................................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 00 2. If death Occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 !Xl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEOUlE G ANO FilE IT AS PART OF THE RETURN, F", dates of dea~ on oraller Juty " 1994 and herore Janua~ " 1995, ~e fax rate imposed on ~e net value 01 transfern to '" I", the use 01 ~esuMving spot/se is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. F", dates 01 dea~ on or after Janua~ 1, 1995, ~e tax rate imposed on ~e net value 01 lransfe~ to '" ror ~e use 01 ~e sUMving spouse is """ (01 pe""'nt [72 P.S. 19116 (al (f. f I (iiJj, The statute does not exem,t a transler to a suNiving spot/se from tax, and ~e sfaturo~ requirements f", disdosure 01 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 fax rate imposed on the net value 01 hansfern from a deceased chi~ twenty..ne years of age '" younger al dea~ ro '" f", ~e use 01 a natural parenl, an adoptive parent, or a stepparent of the child is zero (0) percent [72 PS. ~9116(a)(1.2)]. The tax rate imposed on ~e nel value of hansfers to or f", ~e use of ~e d""'denfs lineal benefidarfes is four and one-hali (4.51 PO""'nt, except as noted in 72 P.S. ~9116(1.2) [72 PS. ~9116(a)(1)]. The tax rate impOSed on the net value 01 lransfe~ 10 '" I", the use of ~e decedent's siblings is lwei" (12) percent [72 P.S. 19116(a)(1 ,3 Il 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-"" EX. (&"".. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mabel I. Smith FILE NUMBER ITEM NUMBER 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. 1. PNC Bank Acct #00-2064-0160 DESCRIPTION VALUE AT DATE OF DEATH 2. Joseph Barnes and Sons, Inc. (security deposit refund) 5,263.22 282.08 3. Verizon (refund) 4. Rumar Publications (refund) 4.49 5. Commonwealth of Pennsylvania (rebate) 13.35 6. Furniture (sold at auction) 172.20 600.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,335.34 ~ REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS t FILE NUMBER ESTATE OF Mabel I. Smith ITEM NUMBER A. Debts of decedent must be reported on Schedule I. 1. FUNERAL EXPENSES: DESCRIPTION AMOUNT 0.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 0.00 Street Address Social Security Number(s)/EIN Number of Personal Representative(s) City Year(s) Commission Paid: . State Zip 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 400.00 Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 30.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Inheritance Tax return filing fee 15.00 8. Certified copies 25.00 0.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 470.00 - "".,,,,,,, ''"'' .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Mabel!. Smith FILE NUMBER NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright Spousal distributions, and transfers under Sec. 9116 (a) (1.2)J RELATIONSHIP TO DECEDENT Do Not list Trustee(s) AMOUNT OR SHARE OF ESTATE Karen D. Weyl daughter /OOO/D -) '7 /-lOV\fPS f ]),- /10. rV(~ b () y~ P;q. 17 /1 {- ~670 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" - 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