Form Rev-1500 - Resident Decedent Inheritance Tax Return

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1505610105

REV-1500

EX (02-11) (FI)

OFFICIAL USE ONLY

PA Department of Revenue

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

(If Applicable) Enter Surviving Spouse’s Information Below

Spouse’s Last Name

Suffix

Spouse’s First Name

Spouse’s Social Security Number

THIS RETURN MUST BE FILED IN DUPLICATE WITH THE

FILL IN APPROPRIATE OVALS BELOW

1. Original Return

2. Supplemental Return

3. Remainder Return (Date of Death

Prior to 12-13-82)

4. Limited Estate

4a. Future Interest Compromise (date of

5. Federal Estate Tax Return Required

death after 12-12-82)

6. Decedent Died Testate

7. Decedent Maintained a Living Trust

8. Total Number of Safe Deposit Boxes

(Attach Copy of Will)

(Attach Copy of Trust.)

9. Litigation Proceeds Received

10. Spousal Poverty Credit (Date of Death

11. Election to Tax under Sec. 9113(A)

Between 12-31-91 and 1-1-95)

(Attach Schedule O)

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

DATE FILED

City or Post Office

State

ZIP Code

Correspondent’s e-mail address:

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.

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 REPRESENTATIVE

DATE

The PA Department of Revenue does NOT accept electronic signatures. Please sign your return.

ADDRESS

PLEASE USE ORIGINAL FORM ONLY

Side 1

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