Inheritance Tax Return Nonresident Decedent (REV ... - FormSend

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Decedent’s Complete Address:STREET ADDRESSCITY STATE ZIPTax Payments and Credits:1. Tax Due (Page 1 Line 19) (1)2. Credits/PaymentsA. Spousal Poverty CreditB. Prior PaymentsC. DiscountTotal Credits ( A + B + C ) (2)3. Interest/Penalty if applicableD. InterestE. PenaltyTotal Interest/Penalty ( D + E ) (3)4. If Line 2 is greater than Line 1 + Line 3, enter the difference.This is the OVERPAYMENT.Check box on Page 1 Line 20 to request a refund (4)5. If Line 1 + Line 3 is greater than Line 2, enter the difference.This is the TAX DUE. (5)A. Enter the interest on the tax due. (5A)B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)Make checks payable to: COMMONWEALTH OF PENNSYLVANIAPROPORTIONATE METHOD WORKSHEET1. Total Pennsylvania real property and tangible personalproperty located in Pennsylvania................................................ (1)2. Total gross assets wherever situated (Page 1 Line 8) .............. (2)3. Proportion (Divide Line 1 by Line 2)........................................................................................(3)4. Total debts and deductions and amounts devised to charitableorganizations (Add Page 1 lines 11 and 13) .............................. (4)5. Taxable Estate as if a Pennsylvania resident(Subtract Line 4 from Line 2)...................................................... (5)6. Spousal transfers (for dates of death after 6-30-94), or transfers underSec. 9116 (a)(1.2) Amount Taxableat % X Proportion (Line 3)...... X = (6)7. Amount Taxable at lineal rate XProportion (Line 3).............................. X = (7)8. Amount Taxable at sibling rate XProportion (Line 3).............................. X = (8)9. Amount Taxable at collateral rate XProportion (Line 3).............................. X = (9)The result of Lines 6 thru 9 are to be entered on Page 1 lines 15 thru 18 of the Tax Computation respectively.PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATEBLOCKS IF THE PROPORTIONATE METHOD IS ELECTED OR IF PENNSYLVANIA REALTY ORTANGIBLE PERSONAL PROPERTY LOCATED IN PENNSYLVANIA WAS TRANSFERREDWITHIN ONE YEAR OF THE DEATH OF THE DECEDENT.1. Did decedent make a transfer and: Yes Noa. retain the use or income of the property transferred; ..............................................................b. retain the right to designate who shall use the property transferred or its income; ................c. retain a reversionary interest; or ..............................................................................................d. receive the promise for life of either payments, benefits or care? ..........................................2. If death occurred after December 12, 1982, did decedent transfer property within one yearof death without receiving adequate consideration? ....................................................................3. Did decedent own an "in trust for" or payable upon death bank account or security at hisor her death? ................................................................................................................................4. Did decedent own an Individual Retirement Account, annuity, or other non-probate propertywhich contains a beneficiary designation? ..........................................................................IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ANDFILE IT AS PART OF THE RETURN.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, itis 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 RETURNADDRESSSIGNATURE OF PREPARER OTHER THAN REPRESENTATIVEADDRESSFor dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to orfor the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of thesurviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, andthe statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is theonly beneficiary.For dates of death on or after July 1, 2000:The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or forthe use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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%, except asnoted in 72 P.S. §9116 (a)(1.2) [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% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether byblood or adoption.DATEDATE
REV-1737-1 EX + (9-00)COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF REVENUEDEPT. 280601HARRISBURG, PA 17128-0601NONRESIDENT DECEDENTAFFIDAVIT OF DOMICILEThis affidavit must be completed and sworn to by a person having personal knowledge of thesefacts, preferably by a surviving spouse or member of the decedent’s family.Name of DecedentDate of DeathLegal Address at Time of Death:Street Address City/Borough State Zip CodeThe following information is submitted in support of the statement that the above individual wasnot domiciled in the Commonwealth of Pennsylvania at the date of death.1. Names and addresses of the decedent’s surviving spouse and members of his/her immediate family:Name and relationship to decedentStreet Address City/Borough State Zip CodeName and relationship to decedentStreet Address City/Borough State Zip CodeName and relationship to decedentStreet Address City/Borough State Zip Code2. Did the decedent ever live in Pennsylvania? Yes NoIf yes, during what periods?3. Did the decedent spend time in Pennsylvania during the five years preceding death ? Yes NoIf yes, during what periods and at what address?4. What was the nature of decedent’s places of residence during the five years immediately preceding death?Indicate whether decedent resided in a house or apartment and whether it was rented or owned by the decedent, and/or whether decedent resided in ahotel or the home of relatives or friends.5. Was the decedent employed during the five years preceding death? Yes NoIf yes, list the name and address of employer(s).6. Did the decedent leave a will? Yes NoIf yes, state the court which admitted the will to probate, the date admitted, and attach a copy, including all codicils, and a certificate of issuance ofletters testamentary.7. If the decedent did not leave a will, has an administrator of his estate been appointed? Yes NoIf yes, state the court which appointed the administrator, the date of appointment, and attach a certificate of the issuance of letters of administration.8. At any time during the last five years did the decedent execute a will, a codicil, trust indenture, deed, mortgage, lease or any other document in whichthe decedent was described as a resident of Pennsylvania? Yes NoIf yes, describe such document.
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