HomeMy WebLinkAbout03-24-06
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
Ai. - ~S
COLMY CODE YEAR
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Johnson, Mar aret A
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
09-22-2005 04-30-1944
(IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INrrIAL)
[ZJ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of'MO)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 48. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 aoo 1-1-95)
SOCIAL SECURITY NUMBER
231-56-6606
TliIS RETURN MUST BE ALEC IN DUPUCATE WIlli TliE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
!Xl 5. Federal Estate Tax Return Required
l 8. ToIal Number of Safe Deposit Boxes
o 11. Election to tax under See. 9113(A) (Attach Sch 0)
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ffi NAME
~ Barr E Musser, CPA, CFP
~ FIRM NAME (If Appticable)
~ Hamilton & Musser, PC, CPA's
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gs TELEPHONE NUMBER
u 717-697-3888 Ext 102
COMPLETE MAILING ADDRESS
176 Cumberland Parkway, Suite 101
Mechanicsburg, PA 17055
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OWned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (tolal 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 Val ue of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which 1I1 election to tax has nol been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Une 13)
SEE INSlRUCTIONS FOR APPUCABlE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
0.00
0.00
0.00
0.00
55,685.00
. .oFFICIAL USE ONLY
0.00
, ,"\
~,~., ''"
1,689,122.00
1,744,807.00
(8)
11,490.00
132,702.00
(11)
(12)
(13)
19. Tax Due
20. 0 I CHEdt~l'lFyou!i'n""~i'" NBr. ,"NG~' ':~i:wD'~;:Ao;t:^,lIriimi' EN:t1
. .. '. . .'-' . .-~.BE~~'q. .A.. ;~ ~v,,,"....."~YV ._ .
X.O_ (15) 0.00
1, 6 0 0 , 615 X .0 4 5 (16) 72,027.68
X .12 (17) 0.00
X .15 (18) 0.00
(19) 72,027.68
TFPA42021F.1
144,192.00
1,600,615.00
0.00
(14)
11600,615.00
"\ (~.)\::l ~
"$ \ -~ ~~ \'~
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Decedent's Complete Address:
. STREET ADDRESS 3 924 Brookridge Drive
CITY h ' b I STATE PA I ZIP 17050
Mec anlCS urq
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
72,027.68
37,000.00
1.947.31
Total Credits (A + 8 + C) (2)
38,947.31
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + 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 Une 2, enter the difference. This is the TAX DUE. (5)
0.00
0.00
33,080.37
A. Enter the interest on the tax due.
(SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
33,080.37
PLEASE ANSVVER THE FOLLOVVlNG 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 [XI
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. 0 [Zj
c. retain a reversionary interest; or ....................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [XI
d. receive the promise for life of either payments, benefits or care? ............................... 0 [XI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. !Xl 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . .. [Xl 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. !Xl 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaKies of perjury, I decla-e that I have examined this return, including accoo1panying 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 prepare!' has any knowledge.
SIGNATURE OF RSON RESPONSI8 E FOR FIL G R URN DATE 1_
~ rnM z. 00 .t:1
FL 32225
ADDRESS
Barry E M~ser, CPA, CFP, 176 Cumberland Parkway, Mechanicsburg PA 17055
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. 99116 (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. 99116 (a) (1.1) (ii)).
The statute does not exemot 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:
rhe 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
larent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)).
I he tax rate imposed on the net value of transfers to or for the use ofthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)].
he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)). A sibling is defined, under Section 9102, as an
ldividual who has at least one parent in common with the decedent, whether by blood or adoption.
TFPA42021F.2
REV-1502 EX... (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Margaret A Johnson
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a
willing buyer and a willing seller, neither being compelled to buy rx sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM
NUMBER
FILE NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
;1FPA42021F3
REV-1503 EX + (1-97) (I)
COMMO~THOFPENNSYLVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Margaret A Johnson
All property jointly-owned with the right of sulVivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
FILE NUMBER
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
f PA42021F.4
REV-1504 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
ESTATE OF
Margaret A Johnson
Schedule C-1 or C-2 (Including all supporting information) must be attached for each ctosely-held corporation/partnership interest ct the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
FILE NUMBER
1.
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
F PA42021F5
REV-1505 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Marqaret A Johnson
FILE NUMBER
1. Name of Corporation
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
ProducUService
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation?
If yes, Position
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
Dyes DNo If yes, DTransfer o Sale Number of Shares
DYes 0 No
Annual Salary $
DYes DNo
Time Devoted to Business
Transferee or Purchaser
Attach a separate sheet for addftional transfers andfor sales.
Consideration $
Date
9. Was there a written shareholder's agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death?
DYes DNo
Dyes DNo
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships?
DYes DNo
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) forthe year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
TFPA42021F.6
REV-1506 EX + (1-97) (I)
COMMON\^JEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
Margaret A Johnson
FILE NUMBER
1. Name of Partnership
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
4. Decedent was a 0 General
Date Business Commenced
Business Reporting Year
State
Zip Code
Product/Service
o limited partner. If decedent was a limited partner, provide in~ial investment $
5.
PERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? Dyes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes ONo If yes, o Transfer o Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? 0 Ves 0 No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? 0 Ves 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death?
Dyes
DNa
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners?
Dyes
DNa
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships?
Dves
DNa
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
f PA42021F.7
REV-1507 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Margaret A Johnson
All property jointly-<lWlled with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
FILE NUMBER
VALUE AT DATE
OF DEATH
TF PA42021F.8
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1508 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Margaret A Johnson
Indude 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
FILE NUMBER
1.
2.
3.
Home contents
Volkswage Passat
Volkswagen Jetta
28,685
24,000
3,000
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
55,685.00
f PA42021F.9
REV-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY -OWNED PROPERTY
FILE NUMBER
ESTATE OF
Margaret A Johnson
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME
ADDRESS
RElATIONSHIP TO DECEDENT
A.
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE 100Ude name of financial institl.tion arO bark accoll1l runber or similar identifying runber. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed. insert additional sheets of the same size)
PA42021F.10
REV-1510 EX + (1-97) (I)
COMMON'WEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Margaret A Johnson
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM ItCLUJE 1li: Nl\ME OF TH: TRANSFEREE, TH:IR RELATIONSHP TO DECEDENT AI{) TH: DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. ATIACHA COPY OF TH: DEED FOR REM. ESTATE. VALUE OF ASSET INTEREST OF APPUC/lBLE)
1. 3924 Brookridge Dr, Son, 6-21-2005 153,690 100 3,000 50,690.00
2 . Wachovia Bank POD account 8,914 100 8,914.00
3. Wachovia Bank POD account 47,893 100 47,893.00
4. Hartford 711476992 109,151 100 09,151.00
5 . Hartford 712168955 105,716 100 05,716.00
6. Hartford 711476999 201,412 100 :>01,412.00
7 . Hartford 711451848 389,389 100 ~89,389.00
8. Gardian Life 101,220 100 01,220.00
9. American Funds Roth IRA 4,737 100 4,737.00
10. Gifts within 1 year of death (5) 55,000 100 55,000.00
11. Mass Mutual 515,000 100 15,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 7, Recapitulation) $ 1,689,122.00
(If more space is needed, insert additional sheets of the same size)
FPA42021F.11
REV-1511 EX + (1-97) (I)
COMMONWEALTH Of PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRAllVE COSTS
ESTATE OF
Margaret A Johnson
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home 1,693
2. Minshew Funeral Home 7,908
3. Other misc costs 314
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representalive(s)
Social Security Number(s) I 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 Stale Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees 1,575
7.
TOTAL (Also enter on line 9. Recapitulation) $ 11 490.00
(If more space is needed. insert additional sheets of the same size)
IFPA42021F.12
REV-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Margaret A Johnson
FILE NUMBER
Include unreimbun;ed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
99,138
33,564
1.
2 .
Wells Fargo Home Mortgage
Wachovia Bank - Equity Line
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
132,702.00
FPA42021F.13
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
MarGaret A Johnson
FILE NUMBER
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tnastee(s)
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Paul E Johnson
1. 3924 Brookridge Drive
Mechanicsburg, PA 17050 Son
2. David Johnson
41670Lawson Circle
Temecula, CA 92592 Son
3. Johnson Trust
41670 Lawson Circle
Temecula, CA 92592 Grandchildren
AMOUNT OR SHARE
OF ESTATE
45 %
40 %
15 %
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
;TFPA42021F.14
0.00
REV-1514 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on Rev-1500 Cover Sheet)
ESTATE OF
FILE NUMBER
Margaret A Johnson
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will D Intervivos Deed of Trust D Other
NAME(S) OF
LIFE TENANT(S)
DATE OF BIRTH
NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
DATE OF DEATH PAYABLE
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
$
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 03 1/2% 06% 0 10%
3. Value of life estate (Line 1 multiplied by Line 2)
o Variable Rate
%
$
NAME(S) OF
ANNUITANT(S)
DATE OF BIRTH
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
ANNUITY IS PAYABLE
o Ufe or 0 Term of Years
o Life or o Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - o Weekly (52) 0 Bi-weekly (26) o Monthly (12)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( )
3. Amount of payout per period
4. Aggregate annual payment, Line 2 mu~iplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate 031/2% 06% 010% o Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
$
0.00
$
$
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13,
15,16 and 17.
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:TF PA42021 F.15
REV-1647 EX + (9-DO)
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF
FILE NUMBER
Margaret A Johnson
This schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment
cannot be established wtth certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3.
4.
5.
IL For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right.
0 Unlimited right of withdrawal 0 Umited right of withdrawal
IlL Explanation of Compromise Offer:
Iv. Summary of Compromise Offer:
1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on line 13 of Cover Sheet) ........... $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 000/0 .......................... $
(also include as part of total shown on line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 06%, 04.5% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
(also include as part of total shown on line 16 of Cover Sheet)
5. Value of Line 1 Taxable at sibling rate (12%)
(also include as part of total shown on line 17 of Cover Sheet) ........... $
6. Value of Line 1 Taxable at collateral rate (15%)
(also include as part of total shown on line 18 of Cover Sheet) ........... $
7. Total value of Future Interest (sum of lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00
(If more space is needed, insert additional sheets of the same size)
rFPA42021F.16
REV-1649 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Margaret A Johnson
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, S, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113 (A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust
or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule
0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is
equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar
arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRlP110N VALLE
Part A Total $ 0 . 0 0
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALLE
Part B Total $
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0.00
IF PA42021 F. 17