Form REV-1500 Inheritance Tax Return - Resident Decedent (REV-1500)

Date of DeaELOW th MMDDYYYY Date of Birth Decedent s First Name MMDDYYYY se s Information Below Suffix Spouse s First Name STATE Suffix (Schedule G) 1 Did decedent make a transfer and: Yes No 1 Original Return 2 Supplemental Return 11 Election to Tax under Sec 9113(A) Between 12 31 91 and 1 1 95) (Attach Schedule O) OffOffOff 1505610105 1505610105 1505610105 1505610205 1505610205 1505610205 3 Remainder Return (Date of Death Prior to 12 13 82) OffOffOff 4 Limited Estate 4a Future Interest Compromise (date of 6 Decedent Died Testate 7 Decedent Maintained a Living Trust 9 Litigation Proceeds Received 10 Spousal Poverty Credit (Date of Death A Prior Payments ADDRESS Amount of Line 14 taxable at collateral rate X 15 Amount of Line 14 taxable at lineal rate X 0 Amount of Line 14 taxable at sibling rate X 12 Amount of Line 14 taxable at the spousal tax rate or transfers under Sec 9116 (a)(1 2) X 0 B Discount Bureau of Individual Taxes Cash Bank Deposits and Miscellaneous Personal Property (Schedule E) 5 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13 City or Post Office State ZIP Code Closely Held Corporation Partnership or Sole Proprietorship (Schedule C) 3 contains a beneficiary designation? Correspondent s e mail address: CORRESPONDENT THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: County Code Year File Number Credits/Payments DATE FILED Debts of Decedent Mortgage Liabilities and Liens (Schedule I) 10 Decedent s Complete Address: Decedent s Last Name DECEDENT S NAME Decedent s Name: Decedent s Social Security Number Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an individual retirement account annuity or other non probate property which EX (02 11) (FI) Federal Estate Tax Return Required death after 12 12 82) FILL IN APPROPRIATE OVALS BELOW FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT First Line of Address For dates of death on or after Jan 1 1995 the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 1994 and before Jan 1 1995 the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P S 9116 (a) (1 1) (i)] For dates of death on or after July 1 2000: Funeral Expenses and Administrative Costs (Schedule H) 9 If death occurred after Dec 12 1982 did decedent transfer property within one year of death If Line 1 + Line 3 is greater than Line 2 enter the difference This is the TAX DUE (5) 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) IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Inter Vivos Transfers & Miscellaneous Non Probate Property Interest Jointly Owned Property (Schedule F) Make check payable to: REGISTER OF WILLS AGENT Mortgages and Notes Receivable (Schedule D) 4 Name Daytime Telephone Number Net Value of Estate (Line 8 minus Line 11) 12 Net Value Subject to Tax (Line 12 minus Line 13) 14 OFFICIAL USE ONLY OffOff OffOff OffOffOff OffOffOff PA Department of Revenue PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PLEASE USE ORIGINAL FORM ONLY PO BOX 280601 Harrisburg PA 17128 0601 INHERITANCE TAX RETURN RESIDENT DECEDENT Real Estate (Schedule A) 1 RECAPITULATION receive the promise for life of either payments benefits or care? REGISTER OF WILLS REGISTER OF WILLS USE ONLY retain a reversionary interest retain the right to designate who shall use the property transferred or its income retain the use or income of the property transferred REV 1500 REV 1500 EX (FI) REV 1500 EX (FI) Page 3 File Number Second Line of Address Separate Billing Requested 6 Separate Billing Requested 7 Side 1 Side 2 SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Social Security Number ENTER DECEDENT INFORMATION B Spouse s Last Name (If Applicable) Enter Surviving Spou Spouse s Social Security Number Stocks and Bonds (Schedule B) 2 STREET ADDRESS TAX CALCULATION SEE INSTRUCTIONS FOR APPLICABLE RATES Tax Due (Page 2 Line 19) (1) TAX DUE 19 Tax Payments and Credits: The tax rate imposed on the net value of transfers from a deceased child 21 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 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 4 5 percent except as noted in [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 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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE Total Credits ( A + B ) (2) Total Deductions (total Lines 9 and 10) 11 Total Gross Assets (total Lines 1 through 7) 8 Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust ) 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 without receiving adequate consideration?