HomeMy WebLinkAbout04-12-06
REV.1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -06 0 0 0 73
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Alexander David M.
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
96- 1 6 - 6 398
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/31/2004
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[XI 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy otWiIl)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ot death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy olTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1.95)
o 3. Remainder Retum (date of death prior to 12-13.82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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FIRM NAME (It Applicable)
TELEPHONE NUMBER
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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 & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
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(8)
0.00
947.29
(11)
(12)
(13)
947.29
-947.29
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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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
19. Tax Due
(14)
-947.29
X _(15)
X _(16)
X .12 (17)
X .15 (18)
(19)
0.00
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > . BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDEAND RECHECK MATH < <
REV-1509 EX + (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Alexander. David M.
FILE NUMBER
21 06
00073
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Eleanor M. Alexander
eM Estates, Lot 157
Newville, PA 17241
wife
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JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Entire Estate Jointly Owned 100. 0.00
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Alexander. David M.
FILE NUMBER
21
06
00073
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Physicians of Rehab
767.99
2.
Lancaster HMA Physicians MGMT Cent Pen
179.30
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
947.29