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Home My WebLink About10-30-06 REV-1500 EX (6-001 W f- ~:!!;(/l Ull::~ WD..U :r:OO UII::...J D..lD D.. <C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W U W C 1&]1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ OF BIRTH (MM-DD-YEAR) D 2. Supplemental Return D 4a. Future Interest Compromise (cate of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy of TrU51) D 10. Spousal Poverty Credit (date 01 death be'Neen 12-31-91 and 1-1-9S) FILE NUMBER cQ L-ll~ COUNTY CODE YEAR D \4 ----- NUMBER SOCIAL SECURITY NUMBER 4 r (" 2- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (dale 01 death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Eloxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) f- Z w C Z o D.. (/l w II:: II:: o U \ '",- 'O~ 1. Real Estate (Schedule A) (1) -; CJ 2. Stocks and Bonds (Schedule B) (2) (J -1'1 c::::> C) -:-0 ("'") (J 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ',1 :-:-:> .-1 ~l] I-- 1-..::) ..- :. -n C.,) , ,_roll 4. Mortgages & Notes Receivable (Schedule D) (4) ,] C) j ;::-.J {OJ ("'~ I ,..;::;:, ") ("~") 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) ,=) --0 t-n --n - --n Z (Schedule E) -- ___.n... C-) :.....,......... 0 ---, .U :_" ' I 6. Jointly Owned Property (Schedule F) (6) .--j ""-) ~ D Separate Billing Requested ;'0 N ...J (7) ::J 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property !:: (Schedule G or L) a. (8) 10 S ~ I <C 8. Total Gross Assets (total Lines 1-7) U ..~ l OS-, Oft -/ w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 0:: ) S-3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) \~ i lo~ . I ~ t~/~. ~t 11. Total Deductions (total Lines 9 & 10) (11) ~ . } 12. Net Value of Estate (Line 8 minus Line 11) (12) \ '~O-7 ~ (~ I z o ~ I- ::J a. :E o U >< ~ 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) (13) (14) x .0 (15) '''\ l X x .0_ (16) x .12 (17) / '\... x .15 (18) (19) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due "'c":;":;'i" -II> >11..'.?4'. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 REV-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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 willing 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. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH / / /' / \ / / I &11. TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1503EX + (1-97) ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION /' VALUE AT DATE OF DEATH 11/1 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER 1. ~, '\.... DESCRIPTION " / '\\ ,/ \, / "X I / / 111 VALUE AT DATE OF DEATH TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1505EX + (1-97) SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Corporation Address City 2. Federal Employer 1.0. Number 3. Type of Business STOCK TYPE Voting / Non-Voting State Zip Code State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year 4. NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK Common $ $ Preferred 5. Was the decedent employed by the Corporation? If yes, Position Time Devoted to Business 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation If yes, Cash Surrender Value $ Owner of the policy pon the death of the deced nt? 0 Yes 0 No roceeds payable $ \ 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. Consideration $ Date 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. DYes 0 No 10. Was the decedent's stock sold? DYes o No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Fomn 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. REV-1506 EX+ (9-00) . , * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER City \ \ \ \ '\\ /-, Date Business Commenced 1. Name of Partnership Address Business Reporting Year \ State Zip Code 2. Federal Employer 1.0. Number 3. Type of Business ... \ \ \ A. Product/Service 4. If decedent was a limited partner, provide initial investment $ 5. B. c. D. 6. 7. Was the Partnersh indebted to the decedent? ................................. 0 Yes 0 No If yes, provide am unt of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold Consideration $ Date Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . . .. 0 Yes 0 No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... 0 Yes 0 No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. L71Yl. o 13. Was the decedent related to any of the partners? .................................... 0 Yes 0 No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER ITEM NUMBER 1. All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH 0#/ TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) REV-l50B EX + 11-97} ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER )0-" or-- IDt c.f Include the proceeds of Iitigati n 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 VALUE AT DATE OF DEATH c..~\eLl. "'0 ~ (0 ~-[i I I TOTAL (Also enteron line 5, Recapitulation) ~~-fi I (If more space is needed, insert additional sheets of the same size) ITEM NUMBER REV-1009 EX. (1-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS A. B. " c. JOINTLY-OWNED PROPERTY: LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPER Include name of financial institution and bank account numbe deed for jointly-held real estate. 1. A. ~L ~ '. FILE NUMBER DATE OF DEATH VALUE OF ASSET RELATIONSHIP TO DECEDENT '10 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV.1510 EX + (1.971 SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 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. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . . _~.; '..l\~:' I?'~... ~,Q: COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ITEM NUMBER A. FILE NUMBER () ') Q/,,, Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: C/UV\YI,J;;..~ / /J'J t?/Jn. . J~~ 1. 1. B. ADMINISTRATIVE COSTS: Personal Representative's Commissions A. (Y\lAri ~ ~ ) 1 q - 'i i1'~ (.;, ...- S1:; ~ State ~ Zip 02- ~ 'b S- Name of Personal Representative(s) -JOt '^ Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City LA 1) (rt' PI. "., ) Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant \ ) (). I/) ~ Ct \r t l' V\. Street Address 1.5"' .B r 0\ d b V (' '1 St. I City lA JOt r r -e v'\. ) State i r Zip 0 Z-ll S .;;- R",tio",";p 01 C',;m,ollo 0'''''001 '--J) Q v fj h:i, r { E )( e <.. V t r. " 4. Probate Fees 5. 6. 7. Accountant's Fees (Y1~" lt~~ J)e:up~ ~ POt, f2..~ ~ Tax Return Preparer's Fees c:. """- TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) ,;-- DIY AMOUNT IJ 5'0 ~ t ) 'J tf D. O~ $ '3 i () ). OB- I REV-1S12 EX -+ (1-97j ESTATE OF COMMONWEALTH OF PENNSYLVANIA l~jHERITANCE TAX RETURN RESIDENT DECEDENT \1\ tV "\ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS F. \ If 0 U i1 ) D~' FILE NUMBER ;) l1JS:- - ) C) i"{ ,- Include un reimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION ~v 'S C- V-ti II {j'~') AMOUNT ",3i.f't17q l(ga~-- \) lq~.7~ v , ~. G 0 \J It- re {\')V\ u{ (0 \/ -e.- pOI. '1 Wl 'E. '"" ...,... ') MeJvc~l B.' Ii ~ TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ ::J j {Q &-. ';-3 ""' 7 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER I .fV\0\('l/\ ~- ~rf)i),I)\i)~ \ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] FILE NUMBER ~ 1 'D -S---"L I 0 I L( RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1. 50v l6\A/\. C ~ o~r c-he. c ""d ~C Cr '\ ) ~l 07, } 1 ~o\~ A. nC\r-t(~ l ~ 5rc~o{ bV("l ~f) W Ol r (' -e. V\ ~. -=r:- ' I D2-8 ~~- J)t\ vOl" t er 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $-1 .5 t;:---; , .3 9 i ~ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-:30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and a ch a copy to the tax return. D Will D Intervivos Deed of Trust D Other o Life or 0 Term of Years o Life or [J Term of Years o Life or [J Term of Years o Life or [J Term of Years o Life or [J Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................... Interest table rate - 031/2% 06% 0 10% 0 Variabl % 3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . .$ o Life or [J Term of Years o Life or 0 Term of Years o Life or [J Term of Years o Life or [] Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) ........... . . . . . . . . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 0 3 1/2% 06% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REY.1644 EX+ (3.84) ~~ COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE "L" REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL FilE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be ed for all remainder returns when an e tion to prepay has been filed under the provisions of Section 714 of the In ritance and Estate Tax Act of 1 61 or to report the invasion of trust principal. (Date) II. Remainder Prepayment: A. Electian to prepay filed with the (attach copy of election) B. Name(s) of life T enant(s) or Annuitant(s) Age on date of election Term of years income or annuity is payable C. Assets: Complete Schedule L-l l. Real Estate 2. Stocks and Bonds 3. Closely Held Stock/Partnership 4. Mortgages and Notes 5. Cash/Misc. Personalfroperty 6. D. l. 2. 3. Value of Unincludable Assets 4. Total from Schedule L-2 s s s s s s s s s III. E. Total value of trust assets (Line C-6 minus line D-4) F. Remainder factor (see Table I or Table" in Instruction Booklet) G. Taxable Remainder value (line E x line F) (Also enter on line 7, Recapitulation) Invasion of Corpus: A. Invasion of corpus s s s (Manth, Day, Year) B. Name(s) of life T enant(s) or Annuitont(s) Date of Birth Age on date corpus consumed Term of years income or annuity is payable C. Corpus consumed D. Remainder factor (see Table I or Table II in Instruction Booklet) E. Taxable value of corpus consumed (line C x Line D) (Also enter on Line 7, Recapitulation) s S $ , REV-1645 EX+ (7-85) '* INHERITANCE TAX SCHEDULE L-l REMAINDER PREPAYMENT ELECTiON -ASSnS- I FILE I'IUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN i<.i:3iDENi DECCDENi I. Estate of (Last Name) II. Item No. Description A. Real Estate (please describe) (First Namel B. c. Total value of stocks nd bonds (include on Section II, . e C-2 on Schedule L) Stock/Partnership (attach Schedule C-1 and/or C-2) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) I Total value of Cosh/Misc. Pars. Property S (include on Section II, Line C-5 on Schedule L) m. TorAl (Also eiitei vii SectiOi1 ::.. Lii1c C-6 on Schedule L) c- I'" (If more space is needed, cttach cdditional 8% x 11 sheets.) (Middle Initial) Value s s REV-1646 EX + (3-84) INHERITANCE TAX . SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L- 1 (please list) / / / / // Total unpaid liabilit;(\i c' ;) (include on Section II, ine 0-1 on Schedule L) B. Unpaid Bequests payable from assets reporte~n Schedule L- 1 (please list) \ \ , j / I I I Total unpaid bequests (, ..' (include on Section II, Line 0-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets S (include on Section II, Line 0-3 on Schedule L) III. TOTAL (Also enter on Section II, Line 0-4 on Schedule L) $ (If more space is needed, attach additional 8Y2 x 11 sheets.) REV-164? EX+ (9-00) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other 5. II. For decedents dying on or after July 1, 1994, if a surviv 9 months of the decedent's death, check the appropriat exercises such withdrawal right. o Unlimited right of withdr III. Explanation of Compromise Offer: I. Beneficiaries NAME OF BENEFICIARY 1. 2. 3. 4. DATE OF BIRTH I AGE TO ~NEAREST BIRTHDAY I I I- spouse exercised or intends to exercise a right 01 withdrawal within ock and attach a copy of the document in which the surviving spouse o Limited right of withdrawal IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ Value of Line 1 passing to spouse at appropriate tax rate Check One 0 6%, 0 3%, 0 0% . . . . . . . . . . . . . . . . . . . . . .$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 0 6%, 0 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ 13. (If more space is needed, insert additional sheets of the same size) .REV.1648 EX (1.92) .- COMMONWEALTH OF PENNSYlANIA INHERITANCE TAX DIVISION ESTATE OF SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91) I FILE NUMBER This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. PART I - CALCULATION OF GROSS ESTATE 1. Taxable Assets total from line 8 (cover sheet) .................................................................... 1. 2. Insurance Proceeds on Life of Decedent .......................................................... ................. 2. 3. Retirement Benefits.............................. ................................................... ..................... 3. 4. Joint Assets with Spouse................................. ..................................... ......................... 4. 5. PA Lottery Winnings .............................................. ........................ .............................. 5. 7. Total Gross Assets (Add lines 1 thru 6)....................:......................................... ............... 7. " " Total Actual Liabilities..... ............................... ........... .......... ........ ....................... .\......... 8. , Net Value of Estate (Subtract line 8 from line 7)..........................................................:..... 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II. 6. 6a. Other Nontaxable Assets: List (Attach schedule if necessar 6. SUBTOTAL (Lines 60, b, c, d) .............................. 8. 9. PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax Returns for decedent and spouse.) Income: 1. T AX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse.................... .. 10. 2a. 3a. b. Decedent.................. . lb. 2b. 3b. c. Joint .......................... 1 c. 2c. 3c. d. Tax Exempt Income..... 1d. 2d. 3d. e. Other Income not listed above ........... 1e. 2e. 3e. f. Total.......................... If. 2f. 3f. 4. Average Joint Exemption Income Calculation 40. Add Joint Exemption Income from above: (If) + (2f) + (3f) = _ (+ 3) 4b. Average Joint Exemption Income ..................................................................................... = If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.......................... 1. 2. Multiply by credit percentage (see instructions) .................................................................. 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. ............................................ 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate............................................................... .......................... ......... 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. 5. REV.1649 EX. (1.97) SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election a lies to the Trust marital, residual A, B, B-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is list on Schedule 0, and b. The value of the trust or similar arrangerne is entered in whole or in part as an ass t on Schedule 0, then the transferor's personal representative may spe 'fically identify the trust (all or a frac' nal portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this esta . If less than the entire value of e trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made e election only as to a fra on of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arran ement included as a able asset on Sched eO. The denominator is e ual to the total value of the trust or similar arrangement. VALUE '\\ " , " Part A Total I $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 A election to tax is bein made. DESCRIPTION VALUE Part B Total $ (If more space is needed, insert additional sheets of the same size) -