HomeMy WebLinkAbout07-26-06
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '1':'
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
IJ. ,
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File Number
05~7
Date of Birth
I(
b
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Decedent's Last Name
Suffix
Decedent's First Name
MI
f'I 0 r
p
(If Applicable) Enter Surviving Spouse's Information Below
SpoJse's Last Name Suffix
First Name
MI
SpoJse's Social
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
c::> 1. Original Return
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::>
c::>
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)
COI~RESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
c::>
$'o_nd rC(..
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P r lesT
7 / 7 <;( 5- rf / 5" 7 7
Finn Name (If Applicable)
REGISTER OF WILLS u~ .oNLY
First line of address
l 137
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fJottd
Second line of address
City or Post Office
fJ? f' ( h CL 17 I C 5b
State
ZIP Code
DATE FilED:
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PI1-
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C.:.
Correspondent's e-ma!1 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.
SIGNAT , E OF PERSON R"E~P2, . NSIBL,? "OR FILI~G RETURN
~/ct--x. ~~ ~ ~/ vf...L124T _
ADDRESS.') /1 . ," .' ;,/7
// -?? ~1d..L"'~~./Pft Pi' /)Le(:jiJl.~<e-~-~ A~ /7 b s~:r- 9727
SIC,NATURE OF PREPARER OTHER THAN REPRESENTATIVE .
DATE
7/20jp~
. ..
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
o 91
I ,-{ L/ ,2 Lj 9
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-Prcbate Property
(Schedule G) c:::> Separate Billing Requested.
8 Total Gross Assets (total Lines 1-7)
.
2.
.
3.
.
4.
.
5.
.
6.
.
7.
.
8. () C' ti V d C) t:) C' 0 . L I CJ
.
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)
9.
. 10.
.
11.
.
12.
.
. . 13.
.
. 14.
-.-.<--__.d~_.._
.-
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15 Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(12) XO_ .
16 AmCL:nt of LlIle 14 taxable
at lineal rate XO .
17 Amount of Line 14 taxable
al sibling r'3te X12 .
18 A'Dount of Line 14 taxable
at coilaterai 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
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15056052048
<=:)
15056052048
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REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
STREET ADDRESS
CITY
STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penaity if applicable
D. Interest
E Penalty
Total interest/Penalty ( D + E )
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.
(}I
(41
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.
(5A\
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5B)
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, did decedent transfer property within one year of death
Without receiving adequate consideration? . ... .............. . .. ....... ....................
3. Did decedent own an "in trust for" or payable ;Jpon death bank account or security at his or her death?..
4. Old decedent own an Individual Retirement Account. annuity, or other non-probate property which
contains a beneficiary designation? ..... .. .......... .............. ............ ....... .
Yes
.....0
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No
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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 sfJouse
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 use of tne surviving spouse is zero (0) percent
(72 P.S. S9116 (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:
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 lhe 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 fer the use of the decedent's lineal beneficiaries is four and one-half 14.5) percent, except as noted in
72 P.S. S9116(1.2) [72 P.S. 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 (72 PS. 89116(8)(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.