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Home My WebLink About11-13-06 i I - ~.., ~ 15056051047 l REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . PO BOX 280601 Harrisbur , PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 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 C) -C) 4. Limited Estate C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 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 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Da ime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes C) Correspondent's e-mail address: DATE }/-13-06 ADDRESS ~ I~ 03 f\f\fI\rl ~ ~9tt \ COM ~'E!\ (~ SIGNATURE OF PRE PARER OTHER THA~ REPRESENTATIVE ~ ( 'l(f) D DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --I --I REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-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) <:::) Separate Billing Requested . . . . . .. 6. 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (Schedule G) <:::) Separate Billing Requested.. . . . . .. 7. -II, ... .- , 1 -r'~ \ Decedent's Social Security Number ,. 15. t'-~" 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 COMPUTAnoN - 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. 16. 17. 18. 20. FlU IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1.5056052048 Side 2 c::> 15056052048 --.J __1 , ~. ~ REV-1500 EX Page 3 File umber Decedent's Complete Address: o~ . ~ ; fi\~ c ~ -\\a- STREET ADDR.. E~ -~ r\l\P 5\- CITY ZIPt '1 O~() Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A Spousal Poverty Credit B. Prior Payments I C. Discount Total Cre<fils J + B + C) 3. InterestIPenalty if applicabte I D. Interest I E. Penalty' - L ..- TOtallnterestlpenaljY ( 0 + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. .. FiJI in oval on Page 2, Line 20 to request a refund. (1) Nd()~ NcX\~ (2) B. Enter the total of Line 5 + 5A This is the BALANCE DUE. NCXlf' ~{ dY\ ~ (5) \-{d (\ e (SA) J~~ (5B) ~\ cY'\ "2 Make Check Payable to: REGISTER OF WlL S, AGENT (3) (4) 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. 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 R'I :: :: ::~~;:~:r::;:..~.~~~~.~~~.~~.~~~~.~~.~~.~~.~~.~~.~~~.:.;.:::::::::::t::::::::::::::::::::::::::::::: B ~ d. receive the promise for life of either payments, benefits or care? ......................................1................................ D ~ 2. If death occurred after December 12, 1982. did decedent transfer property within one year f death without receiving adequate consideration? .............................................................................. ............................... D oq 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D M 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................ ............................... 0 IS! IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHE ULE 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 v lue of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. 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. ~9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assett and filing a tax return are stitl 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 y nger at death to or for the use of a natural parelilt, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)]. I The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiarie is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(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 decedent's siblings is twelve (12) rcent [72 P.S. ~9116(a}(1.3}). A sibling is defined, LInder Section 9102, as an individual who has at least one parent in common with the decedent, whether by bl or adoption.