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Home My WebLink About10-20-06 (2) .-J 15056051047 REV-1500 EX (06-05) PA Department of Revenue * Bureau of Individual Taxes PO BOX 280601 Harrisbwg, PA 17128-{)6()1 ~ ~ ENTER DECEDENT INFoRMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT ;; X' I OFFICIAL USE ONLY County Code Year ..A.............'.'......'........{'............,'...I.:,'.,' ': ;'.1 File Number ;'0 . a' ;''1:(/' i; ..,,~-.>;,_,>.;, ':":.' ':.'~., ;'..}( ~ :.);,f;"',;.~.~,.~'iJ{;:,:.',.,~<;J:>;: c-S;:'::f Date of Birth I i 't' 3., 2., f ,; J-3- Decedenfs Last Name Suffix Decedenfs 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 4. Limited Estate C=> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C=> 2. Supplemental Return 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) CORRESPONDENT - THIS SECTlON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number .. 7{...,i,7'i.)i'-;;8~.,ij\~jr9A 1;' o 8. Total Number of Safe Deposit Boxes C=> 6. Decedent Died Testate (Attach Copy of Will) C=> 9. Litigation Proceeds Received Firm Name (If Applicable) REGISTER OF WILLS USE ONLY City or Post Office 80lL IN6- State 2 ::>:0 !:~?~ J2s:P ,'if iJ ~ '~J( ~ ~ <:::> C"') -., ::.:o'~ .(18 ?ir-... './3 ;t5 r , .4 {r;"J .'.' 11 .. .J C:j ':';:10 7'1 ::Jj o r-, iii v')~x. First line of address 7;611 Second line of address /,r~..~;A c:. E ,S".p 111{..5 'p.A - '. Correspondenfs e-mail address: Under penaIlIe8 of peIjury, I decIIn that I have exam this retum, Including aocompanyIng schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparer titer. than the personal representative is based on all Information of which preparer has any knowledge. SIGNA~SON SIBLE FO FIL RN DATE ADDRESS "76'0 Do(,. tvDOb -r4JfJP~r 80/'/ H~ >~/f#/NIfwS ~"." / 7170'7 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE OJ c.v ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 .-J -.J 15[]56[]52[]48 REV-1500 EX Decedenfs Name: RECAPITULATION 1. Real estate (Schedule A). ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . .. . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::) Separate Billing Requested . . . . . .. 6. 7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::) 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/See 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 See. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .O~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15[]56[]52[]48 Decedenfs Social Security Number , I :: ;i~6,~,;3';, 2. ~;.': r~ 6," ,J,'J-; ;,'_ f~"'''il\.<_, ~;H "~*'--_"'''i!~''-;O;:':'' 'it-_,I.;;_,,,,'",'-';" '.\' '" on '," ,.'-, ,,,. - "':..', ;;,~,,~ , tJ{' "':/~":T';:; 2.,' ,: ~; 3(3 ? <~;'~' ;/~'a'} ;,:, ,'i "'/5r,' ."';<';:";t,:< 'i,-, I .":"""" "'.> ' "".".. Qi' :;..~ 0:; Q' " 7; 1- .:~, 0'; I' c:::) 15[]S6[]S2[]48 ...J ~EV-15OB ","<(6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTAtE Of FILE NUMBER 2-1- o{-o 'tot InckJde the proc:eeds d IitigaIion and the date the proceeds were received by the estate. All property ,;.M~ ~ned willi rigIIt of SUllfi__ ... be ..illl Olt-" on 5cMdI* F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH c:.H~'< /AI' ~ /f cc.oc/,..,T '33J9/ 1;Z '3 8". JI / :z. .5"/917/ A/ 6-'> .A' ~ C p(/;I'V T TOTAL (Also enter on line 5, Recaplulation) $ (If more space is needed. insert additional sheets d the same size) I :J. 7;J., J..Jv. REV-1511 EX+ (12-99). ' . COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDUU H FUNERAL EXPENSES & ADMlNIS1IATIVE COSTS ESTATE OF FIlE NUMBER -;2.. / - Pb - (7 9 () 1 DeIJIs ~ decedent IIIUII be I'IpCIrI8d on ScbeduIe L ITEM NUMBER A. DESCRIPTION 1. FUNERAL. EXPENSES: /~/fF p/,/ /0 ?/lIT P/lIO 1/~t,(lt1 6/o,c:O C/ffn7",rtP/<' >'()c/YrY SA~L rOIf'~AL HOhlJl' HFr/f/GJ: C/?rh7AnPN 5~Y'GP. C'-~6-Y ~po, r{JN~"J. J'4!YIC.~;3uIfO'L S~I//~IIt{J B. ADMINISTRATIVE COSTS: 1. Personal Represenlalive's Commissions Name of Personal Represenldve(s) Social Security Number(s)JEIN Number of Personal RepresentaliYe(s) Street Address City State Zip 2. AItlmey Fees Year(s) Commission Paid: 3. Family Exemption: (If de<<:edenfs address is not the same as claimanfs, aIIach explanation) Claimant Street Address City Stale . Zip 4. Probate Fees Relationship of Claimant to Decedent 5. AccounIant's Fees 7. 6. Tax Return Preparer's Fees AMOUNT Np, 1"4 99.33 ;2.(1(7. 00 TOrAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets ci the same size) -:z CJ9. 33~ REV-'MiOO~ P.-ge3 Decedent's Complete Address: DECEDENT'S NAME F /P ~flI~.r L. ~ Ph'#. ~..rt// & II STREET ADDRESS T# oft> C) />> / FlleNumber A/ - 06. - 0 107' C /?~t:.. / ~~, STATE ;04 CITY Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount '11/79' (1) Total Credits ( A + B + C ) (2) 7"3.71 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) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (5B) QJ.70 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 "In IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... 0 ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [2f 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [3 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [3- 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 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. 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. ~9116 (a) (1.1) (in. 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. ~9116 (a) (1.1) (ii)l. The statute does not exemDt 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. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent. except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is twelve (12) percent [72 P.S. ~9116(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.