REV-1737-A EX (6-08)
OFFICIAL USE ONLY
START
INHERITANCE TAX RETURN
FILE NUMBER
NONRESIDENT DECEDENT
9 9
PO BOX 280601
HARRISBURG, PA 17128-0601
COUNTY CODE
YEAR
NUMBER
USE ALL CAPITAL LETTERS
DECEDENT’S NAME (LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
USE ALL CAPITAL LETTERS
(IF APPLICABLE) SURVIVING SPOUSE’S NAME (LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
1. Original Return
2. Supplemental Return
3. Remainder Return
(date of death prior to 12-13-82)
4. Limited Estate
4a. Future Interest Compromise
5. Federal Estate Tax Return Required
(date of 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
11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95)
(Attach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
USE ALL CAPITAL LETTERS
USE ALL CAPITAL LETTERS
NAME
COMPLETE MAILING ADDRESS
USE ALL CAPITAL LETTERS
FIRM NAME
(If Applicable)
TELEPHONE NUMBER
REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736)
METHOD
Check One:
Flat Rate
Proportionate (Complete Worksheet on Reverse Side)
(1)
OFFICIAL USE ONLY
1. Real Estate (Schedule A)
(2)
2. Stocks and Bonds (Schedule B)
(3)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(Schedule C)
(4)
4. Mortgages & Notes Receivable (Schedule D)
(5)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(6)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
(7)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(8)
8. Total Gross Assets (total Lines 1-7)
(9)
9. Funeral Expenses & Administrative Costs (Schedule H)
(10)
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)
(11)
11. Total Deductions (total Lines 9 & 10)
(12)
12. Net Value of Estate (Line 8 minus Line 11)
(13)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(14)
14. Net Value Subject to Tax (Line 12 minus Line 13)
WHEN PROPORTIONATE METHOD IS ELECTED, REFER TO WORKSHEET ON REVERSE SIDE FOR AMOUNTS TO BE ENTERED ON LINES 15 THRU 18.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
(15)
x .0
rate, or transfers under Sec. 2116 (a)(1.2)
x .0
(16)
16. Amount of Line 14 taxable at lineal rate
x .12
(17)
17. Amount of Line 14 taxable at sibling rate
(18)
x .15
18. Amount of Line 14 taxable at collateral rate
(19)
19. Tax Due - Make check payable to Commonwealth of PA
C
20.
HECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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