HomeMy WebLinkAbout03-15-06
EV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
....
Z
W
C
W
(.)
W
C
DATE OF BIRTH (MM-DD-YEAR)
Januarj 2, 2006 June 15, 1941
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
w
~
:s:~CI)
uO::::'::
IJJQ.(J
:J:OO
(JO::...J
Q.CD
Q.
<t
[X] 1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
FILE NUMBER
(LL-L)~
COUNTY CODE YEAR
JJf2-1Sd-
NUMBER
SOCIAL SECURITY NUMBER
...
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
I-
Z
W
C
Z
o
Q.
CI)
w
0::
0::
o
(J
/"fI"S;$E:<;tj~t4iJI')1~~~r;a~~gft1l.~~6'1:~~::~l.L,,~qFf~J;BQI~:~~,~E:~.m'~~~"~!II:'~.
NAME COMPLETE MAILING ADDRESS
109 Southside Dri-rre
FIRM NAME (If Applicable) l~elf\rille P,'~l. 17241
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1 )
(2)
(3)
(4)
(5)
.
601.. 75
55.no
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
z
o
~
..J
::)
....
c::
<C
(.)
w
0::
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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)
(6)
(7)
(g' .1,628..00
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
~
::)
Q.
:E
o
(.)
><
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0 _ (15)
16. Amount of Line 14 taxable at lineal rate
x .0 _ (16)
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
.~
i<. ,~~~.tl~~t~rFQi:
(8)
(11 )
(12) .970.00
(13)
(14)
(19)
Rev.''''''''.lf-.n '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
US S~i.VING;j BOlJDS ~ 25.00
,1;, 5~ r:' 00
W :;..
TOTAL (Also enter on line 2, Recapitulation) $".00
(If more space is needed. insert additional sheets of the same size)
kEV-1508 EX ~ (1-97}
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
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
VALUE AT DATE
OF DEATH
Bank Acct. -
Soc. Sec.
Di,r ..pd...
llefund C1:
Check
~ .583..00
$
1025
J.9 Q 50
$ 603.75
,*",
.:p
TOTAL (Also enter on line 5, Recapitulation) $ 603.. 7$
(If more space is needed, insert additional sheets of the same size)
REV.1511 EX+ (12-99) 'fe,
~ii&___""_"
'"\;;
. -,
,--'. , -".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cremation :$ 1,539.00
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:
2. Attorney Fees
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 ".00
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 1 628.00
(If more space is needed, insert additional sheets of the same size)