Form Rev-1500 - Resident Decedent Inheritance Tax Return Page 2

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1505614205
REV-1500 EX (FI)
Decedent’s Social Security Number
Decedent’s Name:
RECAPITULATION
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 and Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and 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.
8. Total Gross Assets (total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Funeral Expenses and Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . 9.
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I). . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/Sec. 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 CALCULATION - 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
15.
16. Amount of Line 14 taxable
at lineal rate X .0
16.
17. Amount of Line 14 taxable
at sibling rate X .12
17.
18. Amount of Line 14 taxable
at collateral rate X .15
18.
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of perjury, I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
The PA Department of Revenue does NOT accept electronic signatures. Please sign your return.
ADDRESS
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN
DATE
The PA Department of Revenue does NOT accept electronic signatures. Please sign your return.
ADDRESS
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