HomeMy WebLinkAbout06-12-06
....J
15056041046
REV-1500 EX (05-04)
PA Department of Revenue
Bureau of Individual Taxes
Dept. 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
i I 0 5
(14) q
Date of Birth
J l~)S 0CiJ j/1 ' L/
Decedent's Last Name
V I C K
OSo3L60S
() 30 0/ '1 '8S
Suffix
Decedent's First Name
MI
SEll-!
A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
- 1. Original Return C=> 2. Supplemental Return C=> 3 Remainder Return (date of death
prior to 12-13-82)
C=> 4. Limited Estate C=> 4a. Future Interest Compromise (date of C=> 5. Federal Estate Tax Return Required
death after 12-12-82) 2
C=> 6. Decedent Died Testate C=> 7. Decedent Maintained a Living Trust 8 Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C=> 9 Litigation Proceeds Received 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 Daytime Telephone Number
5' ~ ~ OJ }-. i? r;
Firm Name (IrAPPliCable)
L.
gc;,nkc
3 r
7 I '7 ) (p u 7S- (;
REGISTER OF WillS USE ONLY
r~c" r 3 b "\ ) S
First line of address
fd-e.
)+ e In
55) 0
T(1 t1di e
lLo~d
Second line of address
City or Post Office
en Mf
State
ZIP Code
DATE FILED
~I
f .~
J '7 c
Correspondent's e-mail address:
s-~"\t(;
Under penalties of perJury, I declare that I have examined this return, includin9 accompanying schedules and statements. and to the best of my knowledge and belief.
it IS true, corre n omplete. Declaration of preparer other than the personal representative is based on all informc,tion of which preparer has any knowledge.
N RESPONSIBLE FOR FILING RETURN
DATE
(j J (j Ie) (:
I I
SIGNATURE
ADDRESS ,. "/ ~ )
'35,-11) In h(J\.6 (-vi' 0:\ Vl'f' {" ( ,p~L)
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE f
i 7 t I)
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041046
15056041046
-.-J
--l
~ I I )<~1
O~:>-'i'X
15056042047
REV-1500 EX
Decedents Name S(2 -i I" A \ fv:-K-
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)
4. Mortgages & Notes Receivable (Schedule D) .
5 Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) .
6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested. . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::> Separate Billing Requested..
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)
14 Net Value Subject to Tax (Line 12 minus Line 13)
. . 10.
11.
12.
. . 13.
14.
Decedent's Social Security Number
( C' S 0~) S- ~ I If
1.
2.
3.
4.
5.
6.
7.
8.
9.
.
.
.
.
j
o 6' ,~- ..-
.0 :>
'- I "".z...
. )
.
'\
'75 '"' I
., .6'
\ ~"j s
'7 ., t, S .
3" G y L~ . 3 0
'1 r. - 1\ 'I
~ v L,
. \
\
5
5
I
(\
.ll '3)
.
o.ou
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) XO_
16 Amount of Line 14 taxable
at lineal rate XO
17 Amount of Line 14 taxable
at sibling rate X .12
18 Amount of Line 14 taxable
at collateral rate X .15
.
.
.
19. TAX DUE
15.
16.
17.
18.
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042047
.
.
.
.
C>
15056042047
-.-J
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
.;-'J
Je Jrj
STREET ADDRESS
(p Lf (
A. \1" (~.K
L I ~'iolsaL1
(2() .
CITY
STATE
PA
(bv-i ,~\(2
Tax Payments and Credits:
1. Tax Due (page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
- 0-
Total Credits (A + 8 + C ) (2)
ZIP
l '70/]
(3)
(4)
(5)
(5A)
(58) ~ 0---
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E )
4. If line 2 IS greater than Line 1 + line 3, enter the difference. This IS the OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund.
5. If Line 1 + line 3 is greater than Line 2, enter the difference. Tris is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of line 5 + 5A. This IS the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;...... ............ .....
b. retain the right to deSignate who shall use the property transferred or its income: .. . .
c. retain a reversionary interest; or............ . . ...............
d. receive the promise for life of either payments, benefits or care?...
2. If death occurred after December 12,1982, dd decedent transfer property Within one year of death
without receiving adequate consideration? .... .................
3 Did decedent own an "In trust for" or payable upon death bank account or security at his or her death' .
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .... . ............. .
Yes
n
.. LJ
... LJ
.... [J
..........0
o
II
............ :----1
I
No
~
[2
~
W
Ea
o
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. S9116 (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 Lise of the surviving spouse is zero (0) percent
[72 PS. S9116 (a) (1.1) (ii)]. The statute does not exempt 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:
The 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 parent, or a stepparent of the child is zero (0) percent [72 P.S. s9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. S9116(1.2) [72 PS. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [l2 P.S. s9116(a)(1.3)]. 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
S '2- ~t~ A 'v (cL 7 OLJ,S~- Do '-(2/j
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 willmg seller, neither being compelled to buy or 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.
I
I
I
I
I
I
I
I
I
I
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
tJ.) f~
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV.\503 Ex. (1.97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~e4[" A. V'tCr-..
FILE I~UMBER
"7. LSD S- - 00""; 2 q
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
/vo~
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX+ (1-97) {.
~.,~,~
fP(~\'f{ji: :>~
'"';.,;~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF r. .
~+h ~,\I'(.\(-
FILE NUMBER
L ODS': QO '..j 7 I}
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporatlon!partner,:hip interest of the decedent. other than a
sole-proprietorship See instructons for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
r.Jo r~,
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX+ (1-97) _
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
s~+~ A. t/iCt.
FILE NUMBER
? ('IV ~-- --- (X)I./ 21
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1_
(lu"M
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-15G8 EX + (1.97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Se_+/l .Ii. V~ ( t
FilE NUMBER
? {FJ' S-= O()\j Z 'J
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
Z {.)O ~ S,-/z..vl~\ O'\otl)(C'tCu. (~J-/.r(;1-4?frl I~ fJ1(H~'J
\kl'ltCCl O(~({cLz-+ KSvl+"l) t':' rlR.C2.c.lt",T J
OVO~+k) S-oJ\J(~'y \k, l \'''~, 6n 1.'1
VALUE AT DATE
OF DEATH
1,..-- .
..) ('. ,))
.-
L...
('.~ \ (-.;c. ~I..(,I' S:o rlC~ l ~j (1 t;~ ~i
CA/J pit s \ y\eJ l~">.S
~(C).rd C:h ; J
1>fov,OTJ
s.
r~d h t f \ v'(}v~ ~A-. '( C 1w,J. /( S
q ~J', sS-
TOTAL (Also enter on line 5 Recapitulation) $ j I / () g 0::C
(If more space is needed, insert additional sheets of the same size)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMUIWEAc ,H OF PENNS\ LVANIA
!tJHE"ITM;CE T A..~ RETURN
R[SOENT OECEDEfF
ESTATE OF r--. I fi \ J I
,_______~~~ ~~\Cl(
FILE NUMBER
<? (ru ~- 0 () (/2 ,}
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIW,G JOIN' iENArH(S) NAME
ADDRESS
RELA TIONSHIP
Lt Ltl L\V'(:h~'1 R..d. G~;d{" /11 no; '5
r-='{:\.+J..-V"
.A LCdH' I~ L, J lLt.
B. A n3.l-e ')ve \),c t
(9 q 1 L\ ,~>:l ~J 1-((. C(~ it jC, I f~~ I )()) .~
('1\ ,A l\~/
c
JOINTLY.OWNED PROPERTY
I DATE DESCRIPTION OF PROPERTY ._-
I LETTEP i %OF
iTEM FOR JOlin i MADE include name of financial institution and bank account number or similar identifying number Attach DATE OF DEATH DEeDS
NUMBER. TENAfl' ! .OINT . deed for Jointly-held real estate. VALUE. OF ASSET INTEREST DE'
I . .,-.
i Yr.Q rn b-U S 'S\: f,~d rt- Ut'I C'11 i 3(J ~Ylg" .,) i L:i . 1.,. ?)' 7'"
1. A. I jqqg , _1 }.p ,).),
6. I
i .
I
.., A rrJ~tx,.s 's+ CAtA:.r (,iV'/ or- 13,'7 0<1 ~- 6C ((I S-,
L, , ,rr ci B f 1 ", 33.33
I I, _'\ L-
(:>
I
I
I
I
I
I I
I
I I
I
I I
I
I I
I
I
I I
I I
TOTAL (Also enter on line 6, Recapitulation) $ 2 7, 3
. ,
GtTt= ()~ :)~~_ L :
-i: b I
I. 1 j
(../
(If more space is needed, Insert additional sheets of the same size)
PEV.1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF < ..[). + 1/
,)~ r. 4- \J\ct
..
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
Z (J7JJ :{)OV /(1
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 COliER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM I/\JCLUDE THE NAME O~ THE TRANSFEREE, THEiR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IF APPliCABLE)
1.
rJL) VI e
TOTAL (Also enter on line 7, Recapitulation) $
. .
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
t\,,~ ,.0
,1k~lf1jl ~"
.~~,,?.:~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF c;: J / f. /' .'-
~T 1 . N. L t ( {C
FILE NUMBER
? {JZJ--S< 0(> V l?
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
ELAJ' 'j ~riJtl-J.d Fv/\eFOJ ~lt(N 11",.r.(. , "
'. //1 lr-orV'I,1-r (-, (fY'(;..r(\:,rj
('c;rll..1u ,Ylf,/}.lfV;'" ~,> 'lJ!,.-VV\, 1'1- '
'"
'5,?/7.ZC'
)
L,FJ-l,SO
L
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
S7 I (0
5. Accountant's Fees
6. Tax Return Preparer's Fees
C ~-t<'~ Ad \v~r-t ,'y yrJ/l~ / pvb i. C:--{I (r~ ,
Ot, C u.l'~b2/lc-\ril C~V-l"'--\-\'-J lcUAJ 0,Olin,()-1
b, r (1'1' I, ) U ~R/}/\+) (l-k I
7,
{s.oo
;O'3,ttS
TOTAL (Also enter on line 9, Flecapitulation) $ III '3 3S, IS-
(If more space is needed, insert additional sheets of the same size)
REV-1S12 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF r_ .,'
~ -fA A. t/) C k
FILE NUMBER
Z ()(J.J-:: O()V? '7
ITEM
NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses,
-,-- VALUE AT DA~-
OF DEATH
r-
--.) .
7.,
J.
L/
DESCRIPTION
('~, VI'\ !::~rl 0 "d l:>(Jwi \"VIII .11 (}1L'J..//c'I'1C~
1-\lj5V1'kLl v"r~ob (,</..I (y/\^-ter -i.J.i)jfr~c..1 0CdO.nU
IJv- S h- '(J11 (f'.( 11, (:'" r (VI/-/' -ff -. f J"I '-I S'I C I c[ VI P;'t ((111 (V
~I' S'~- (1,..:)(') I~ l))I':/(\'r) UVlY~U.rf>cJ IDA.. Y) /3?Cflf.-oz
yY) f Y'I\~:':' , __ I '_,_ $, ._ ,
lot c-,,\ ~. D 1,--1(. <' \..! ~ '-;- 3 - q z,), ~ ~
A~ rl CPt '" cQJ2,L
.:J.~rr1 ' J/~WI Yj
(y.
TOTAL (Also enter on line 10, Recapitulation) $ 7 3DS', IJ~
(If more space is needed, insert additional sheets of the same size)
I, () iI , 7 L
/ L~V ltl
) ..... r-
tf, '2 .f j'-. Co
1ZS-.43
3S.\..(S
LJ S rf'.\
REV-1513 EX+ (9-00) ,
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
se jA 4. LIt' c k.
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Lu n ('lit:. L. J. c t:-
V L\ I L 11'\ dSQ( (2J.. (}!rkJ2 I P/i IlD J ~
14 V~{C", <;. ~f \c/<::'i) . . 1-'
, 'CO 0 I (JcifitJ'{J fA I 70l ')
G) ~ I C 111( .ydl f_C" I '
1.
'Z
"
FILE NUMBER
l- (J6 J-:. ()O \.j zq
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not ListTrustee(s) OF ESTATE
p~+J\er
(!) Of i~_!
St) ~;)
Su~)
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 11- 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)