1505614105
EX (03-14) (FI)
REV-1500
OFFICIAL USE ONLY
County Code Year
File Number
Bureau of Individual Taxes
INHERITANCE TAX RETURN
PO BOX 280601
RESIDENT DECEDENT
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number
Date of Death
MMDDYYYY
Date of Birth
MMDDYYYY
START
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
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
4. Agriculture Exemption (date of
5. Future Interest Compromise (date of
6. Federal Estate Tax Return Required
death on or after 7-1-2012)
death after 12-12-82)
7. Decedent Died Testate
8. Decedent Maintained a Living Trust
9. Total Number of Safe Deposit Boxes
(Attach copy of will.)
(Attach copy of trust.)
10. Litigation Proceeds Received
11. Non-Probate Transferee Return
12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets
14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT –
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
First Line of Address
Second Line of Address
City or Post Office
State
ZIP Code
Correspondent’s email address:
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
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