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Home My WebLink About09-13-06 .~.-J 1505bD4104b REV-1500 EX (05-04) PA Department of Revenue *' Bureau of Individual Taxes Dep!. 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 Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (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 <=:) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required o 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ 8. Total Number of Safe Deposit Boxes 4. Limited Estate <=:) _ 6. Decedent Died Testate . .' (Attach Copy of Will) Q . 9. Litigation Pro~eds Received Firm Name (If Applicable) REGISTER~F WILLS US~LY '- C~") (= 0 c::n '- ~5,J (/) '.U 11' . ;~,T.P -u -"7j'1'l :::':J W >, u ::1: =-i{ C) ~i5 - - ~::;-~ C:J (',) C) 'I. -'T'1 , :.!..] , ~~;~ )C~ c...n 0:> Correspondent's e-mail 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. SIGNATURE OF FOR FILING RETURN DATE ~ I"!, 'Z..OO<O SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041D46 15056041046 ......J .-J REV-1500 EX Decedent's Name: RECAPITULATION 1.5056042047 1. Real estate (Schedule A). ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sol~~Proprietorship (Schedule C) . .. .. 3. 't . ,- . , '~'. :'"1. . , ;' .' :", ; ,',.j".. ;.;., -, '.", ;.' " . ,,- . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schepule F) c::::) Separate BiUing Requested . . . . . ., 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Cj Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 8. 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). . . . . . . . .. . . . . ..... . . .. .. . . . . ...... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O ~ 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 19. 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056042047 Side 2 c:::> 15056042047 ......J REV-1500 ~~ Page 3, Decedent's Complete Address: DECEDENT'S NAME ~..o ~. \",~ ~< STREET ADDRESS S J q ~ C\ SI '^M\X-\ S\- File Number e,~C"\~ ~e\..O CITY ~"""-("\ ~"'\J ~V ") STATE \.A)V ~c ~ "'\ \ "\ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payment~ A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) %.) o5~. 00 Total Credits ( A + 8 + C ) (2) ct> 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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. (4) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (58) 8'J O!) ~. 00 o '6) C> 5::) . C(J 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax 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: Yes No a. retain the use or income of the property transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [2l 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D a 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. Ii. ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......................................................................................................................1 g D 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. 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 zero (0) percent [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 retum 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. 99116(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. 99116(1.2) [72 P.S. 99116(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 P.S. 99116(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. REV-1502 EX+ (6-98) . .' '. . COMMOt.lWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER --::r Q5e.; , ~ '\ ~ All real prope 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 or sell, both having reasonable knowledge of the relevant facts. Real property which Is Jolntly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. VALUE AT DATE DESCRIPTION OF DEATH \~c.?,,\ ~cJ.n"+ ~tr'\ 'l:\~ ~\~\c... ~ OO\~ \~, 000 I J ~e~ \C\n'~ .. ~ bo \+ '" JJn...., ~ ~ ~ \.u~\nJr b~\Qv" <'r~ ~w~ ~ C'\o ~~)) ~e't\ ~ '0:1 ~ "'-' ~ ~ 'CoC"1\ &\~ "- ~ f.w- ~ c: \l j).. J SO"~ ,,\, d~rt.c& Jo I't\\~~ ~\ "2.3~. ~ ~ '(.(.,~ ~ ~ .s~, ~~(.. ~ \"n~ n~ 0(' .t.c('~rS * S. a. ~"'~hf,t' Se\)~ l.\ft Je.~ ..a..e.~ ~~ ~ \~ ~ ~ \l..o~: t.- ~ \0 "" ~~\. ~ I , ~"""'~t. ~ \c.."l ".~ 0" ~G'~(.C"\~ 08- ",~ ~~6"('J "ec;-~ u., dc...~n.(.4 3ofl"\,n~ '" u. \.. 1:!>). '"i.l -k<A- \.0 Q... ~ D \ nl- ." """'- ~~ c* ~ ~\~~ ~ ,.~ ~ ~ C' ~ Q," ~ . ,,",(.;0 cc.. ~ ~ eeC'\ ~(" ~ ~",* ~~~ 1\~J t\or", '"\t- Q,~~~ \5 1'\\ I n ~ e""6~ \ "La C-0- ~ ~ ~~ ~ '~\~I\~~ . TOTAL (Also enter on line 1, Recapitulation) $ \ ~ -, J <:XY.J. - (If more space is needed, insert additional sheets of the same size) ~,~~..,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA~ ' ~~~~\~ T\, \-\ If an asset was made joint within one year of the decedenfs date of death, It must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. ~\f'\ ~, \,..M- JT~ ~2~- 3.&..ro~ S~ ~.c\~ \~ wV 2-0""'\\'1 ~of\ B. c. JOINTLY-OWNED PROPERTY: LmER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financlallnstilution and bank account number or similar Identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. ~r lY'\ , T 1> c..n \<. - ~c.~""~ o..c <..00'"* .J 1..\) 500 \ooJ '-\ 500 - \<\G~ ~~bL\ \is'L . TOTAL,(Also enter on line 6, Recapitulation) $ ~1500,- (If more space is needed, insert additional sheets of the same size) REV-~"3 EX+ (!HlO*, . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER ESTATE:; Q;en,", \ () t' -r (' : \-\- J NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~\.,':hO --:r. \'\'~J -.r (" " 1. q ~. 0 C\m\JC\ ~\- c.M (.1(\ e ~ T O~ w V '2. 5 \.\\ '-\ RELATIONSHIP TO DECEDENT Do Not List Trustee(s) :500 ,. 7~~~~ -S, \"~:\-\.. \ 1 \\.\. ~ L.\ 11 S -\. \~C"C\~\~~ . \> "" '1 0 r~ SOi"' AMOUNT OR SHARE OF ESTATE 50"0 5Ob/o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n 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) ~'''m.:'", . COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF 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 INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE . VALUE OF ASSET INTEREST (IF APPLICABLE \ NUMBER 1. ~(\0\\j - We.b~~('\ - ~~'n L\5 \%'1. q 1 L.\5j \ %<1. L\ 1 VLo~\~&33 J 'A, .,~. CO \&.\ -n,. , TOTAL (Also enter on line 7, Recapitulation) $ 5'\ <1 a~.- 00 (If more space is needed, insert additional sheets of the same size) - ---1 REV.1511 EX+ (12.99) . . ,- . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF \ ::s- ae.. ~Y'\ \llf SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER \('~ \-\- Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: r,V-',~~ ~o~e~ r~l ~~ ~. ~(\o\J<''' ~. ~\\~ \(. l>A \'0\3 ~e 1:nc:.. ~ ~ ~, ,<;~. 60 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees "C\.L\.oO 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 1 0 8 t,. (J.:J (If more space is needed, insert additional sheets of the same size) . REV-:')""(12,"') ... , \ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~bv\CA.(,\c(., Se.('\jtU&.\o ~~\- ~O~ &viS" ~~~ \.\.\ \ ~O(l~~ ~\<- ~~'O,~ \-\omc..., ~lL(' cS. Cen~\ ~v.. .~1s ~- e('\ok rx ~~ ~A rl02S ~ ~ ~\1... ...,.. a..,r.~ c-\~ ~ "3S. ,5 ~~. b& 5J 0c::X.? - 00 \ 3. o. 00 \ \) \"LL "-\t' TOTAL (Also enter on line 10, Recapitulation) $ \.., I (., \ 1.. l I (If more space is needed, insert additional sheets of the same size) Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, P A 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphans' Court Kirk S. Sohonage, Esq. Solicitor Phone: (717) 240-6345 Fax: (717)240-7797 OFFICES OF Register of wills and Clerk of the Orphans' Court County of Cumberland FACSIMILE TRANSMITTAL SHEET Earlene FROM: Angelia Weber PHONE: 717-240-5340 TO: COMPANY: Dept of Revenue FAX NUMBER: 717 772 0412 DATE: Cktober 2, 2006 RE: TOTAL NO. OF PAGES INQUDING COVER: Josephine Tritt 1 o URGENT 0 FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE PLEASE SEE ATTACHED THE SECOND PAGE OF THE INH TAX RETURN THAT YOU REQUESTED.