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Home My WebLink About10-13-06 (2) .-J 15056051047 REV.1500 EX (06-05) PA Department of Revenue ,. Bureau of Indivldual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFoRMATION BELOW Social Security Number Date of Death IN~~~::N;E ;~E~~~RN l\:z. I OFFICIAL USE ONLY County Code Year File Number ''':','' .. '... " ;',',.... :', ":....-:~.: ii.' "';"-." ,'J.: .. i C ...' - ;..:...~..-'. .~..,,':._'.},' ~~ ,(Jio 'O::,,'t f!~Lf' Date of Birth I If 6 3 2.. y, 3-1- f) ~ o 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 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::::> 6. Decedent Died Testate (Attach Copy of Will) c::::> 9. Litigation Proceeds Received 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 Nurnber I o 8. Total Number of Safe Deposit Boxes iW' I L '.t. I ,'ANt Finn Name (If Applicable) r :,: ""<,';"';" - ":'?T' Pi. A 11N ..." ....fF., V J G. II 7/7'~5i REGISTER OF WILLS USE ONLY City or Post Office State (") r;:: ~o !~?ij <2 s;; p OJ,::: :2; CQ ,'::::; Cr:, .; ~ '_.Je D ~ ~ R '"-4 _ -:ta '~J C!"'i "Ie:> -C5 "rrftJ r ,-.,-::1 ~,' rn .:,7 c:J -"ic10 ::',-:: :R ;.:.::,,~ r'-. f/i "'~~.! ~11' First line of address )6..,17 DO Second line of address - ~ 8 (J I L I N6- PA .::.: - .. Correspondent's e-mail address: Under penallles of peljury, I declare that I have e it is true. correct and complete. Declaration of preparer SIGNA~ERSON SIBLE FO Fill ADDRESS '7 &' 0 Do~ evOOb -r4JfR.Jr.r f30IL/ #6-- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE c.n c..., this retum, InclucIIng accompanying schedules and statements, and to the best of my knowledge and bellef, r than the personal representative is based on all information of which preparer has any knowledge. URN DATE Sr:',.,e / N,f..-S P;9 / "7 DC"" DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 .....J -.J 15056052048 REV-1500 EX Decedenfs Social Security Number ;- ~"'6J:'3" i'~, ;:;" 'J-:1-; ,.,>.-~,.,),.""""":",.,,,,:, .~.' :,':" """ "'.:1 -0 ,il 2ciO:',;h',i}.'t'. "">''''''''<-:''F_; 'i_~i".: .,_, .' ',.,_.. -j}.,~,.,. " ','. _..:-:, -,- "0',,' ',_ .. ;', >.,..,.. ~:...,., O".i.-;' Decedent's Name: RECAPITULATION 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Real estate (Schedule A). ................. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation. Partnership or SoIe-Proprietorship (Schedule C) .. . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Properly (Schedule F) c;::) Separate Billing Requested . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c;::) Separate Billing Requested. . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent. Mortgage liabilities. & liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Unes 9 & 10). . .. .. .. . .. . .. . . . . . . . .. . . .. . .. . .. . . 11. 12. Net Value of Estate (Une 8 minus Une 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . .. . . . . . . . . . . . . . . . . . . 13. 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (aX1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X .0't,S 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE... .... .. . . . . .. ......... . . . . . . . . . . . .. ... . . .. ... .......... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c;::) Side 2 L 15056052048 15056052048 .-J ':"V-1508 E,X. (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE Of FILE NUMBER :2../~ O{-o CfO'/ Include the proceeds clltigaIion and the date the proceedI were received by the estate. AI property ~ owned willi rigIIt flI survivolsNp __ be d..... on ScbeduIe F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH / :z.. CHpc.-~ /AI' I- A cc. oc./""T '33J9/ 1:Z:3 8'- JI .sAP//N6-~ /?C.C/7(//V/ TOTAL (Also enter on line 5, Recapilulltion) S (If more space is needed, insert additional sheets cI the same size) /:J. 7J..,J..~ REV.1511 EX+ (12-99)~_ ' . ~ COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMlNlS1RAllVE COSTS ESTATE OF AlE NUMBER -;2.. / - t:Jb - (7 9 () f DIbIs of dlcedenllIIIIII be reported on ScIIeduIe L ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: ,~-1'F ?~/P ?lfF P/1/0 t:::/f.tFh?.-fnll# ><Jc/Yr'l .5APL F"O/fITXAL HomJr 1/ ~(, tJP 6/d,c:O Np, 1"4 '19 ,33 ;2.{7(7. 00 II ,-r/f/c..t: c/?rh7ATlQA/ 5P111!.Y/G/E. C~~Q..~ ~po, r(JNJT1(,AJ. J'~/C.~j3UIfI/" $.o1'<'PIG.tJt{J B. ADMINISTRATIVE COSTS: 1. Personal Represenlative's Commissions Name of Personal Represenlalive(s) Social Security Number(s)JEIN Number of Personal RepresenIative(s) Street Address City State Zip Year(s) Commission Paid: 2. AIbney Fees 3. Family Exemption: (If decedenfs address is not the same as claimant's, aIIach explanation) Claimant Street Address City Stale . Zip Relationship of Claimant to Decedent 4. Probate Fees 5. AccounIanfs Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) S (If more space is needed, insert additional sheets d the same size) ~ 19. 3.1~ REV-16OO~ Page 3 Decedent's Complete Address: DECEDENT'S NAME F /P ~7V~';- L ~ ,PAil #. ~..rv/ 0 II STREET ADDRESS r#O~ i7m/ File Number ?-.-I - 0 6 - (7 '1 0 7' CIlY C r?~~ /~~, STATE p/? Tax Payments and Credits: 1. Tax Due (Page 2Une 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) '11/ 7 r Total Credits ( A + 8 + C ) (2) lf3.71 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 Une 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) /f 3.75 5. If Une 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;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [::J d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 0' 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 0' 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? ........................................................................................................................ D 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) (i)). For dates of death on or after January 1 J 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 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 the use of a natural parent, an adoptive paren~ 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 decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. !9116(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 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.