REV-1737-A - Inheritance Tax Return - Nonresident Decedent
EX (05-15)
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
File Number
Decedent’s Name (Last, First and Middle Initial)
(If Applicable) Enter Surviving Spouse’s Name (Last, First and Middle Initial)
Social Security Number
Social Security Number
ENTER DECEDENT INFORMATION BELOW
(MMDDYYYY)
Date of Death Date of Birth
(MMDDYYYY)
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 5. Future Interest Compromise 6. Federal Estate Tax Return Required
(date of death on or after 7-1-2012) (date of 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. Non-Probate Transferee Return 11. Spouse is Sole Beneficiary 12. Deferral/Election of Spousal Trusts
(Schedule F and G assets only) (No Trust involved)
REV-1737-A
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
State
City or Post Office
First Line of Address
Second Line of Address
ZIP Code
Daytime Telephone Number
Name
Correspondent’s email address: __________________________________________________________________________________________
CHECK ONE: Flat Rate Proportionate (Complete Worksheet on Page 3)
REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736)
PAGE 1
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
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
INTERNAL USE ONLY
DATE FILED
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