PDF document
- 1 -
      REV-1514 EX+ (1-15)
                                                              SCHEDULE K
                                                       LIFE ESTATE, ANNUITY 
         BUREAU OF INDIVIDUAL TAXES
         PO BOX 280601                                      & TERM CERTAIN
         HARRISBURG PA 17128-0601
START ESTATE OF                                                                                            FILE NUMBER
Ü
      This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, 
                        actuarial factors for single-life calculations can be obtained from the Department of Revenue.
         Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
                                  and in Aleph Volume for dates of death from 5-1-99 and thereafter.
                Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return.
                        oWill                          oIntervivos Deed of TrustOther                      o
                                                LIFE ESTATE INTEREST CALCULATION
                        NAME OF LIFE TENANTDATE OF BIRTHNEAREST AGE ATTERM OF YEARS 
                                                                                                       DATE OF DEATHLIFE ESTATE IS PAYABLE
                                                                                                           oLife oroTerm of Years
                                                                                                           oLife oroTerm of Years
                                                                                                           oLife orTermo of Years 
                                                                                                           oLife orTermo of Years
                                                                                                           oLife orTermo of Years

      1. Value of fund from which life estate is payable  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
      2. Actuarial factor per appropriate table  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
      Interest table rateo3.5%6%10%Variableo o Rate%o                     _________
      3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

                                                     ANNUITY INTEREST CALCULATION
                   NAME OF LIFE ANNUITANTDATE OF BIRTHNEAREST AGE ATTERM OF YEARS 
                                                                                                       DATE OF DEATHANNUITY IS PAYABLE
                                                                                                           oLife orTermo of Years
                                                                                                           oLife orTermo of Years
                                                                                                           oLife orTermo of Years
                                                                                                           oLife orTermo of Years

      1. Value of fund from which annuity is payable  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
      2. Check appropriate block below and enter corresponding number                                                                      . . . . . . . . . . . . . . . . . . . . . . . . .
      Frequency of payoutoWeekly (52)Bi-weeklyo          (26)Monthly (12)o
         oQuarterly (4)Semi-annuallyo   (2)Annuallyo        (1)Other (   o)
      3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
      4. Aggregate annual payment, Line 2 multiplied by Line 3  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
      5. Annuity Factor (see instructions)
      Interest table rateo –3.5%6%o 10%Variableo     o Rate%               _________
      6. Adjustment Factor (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
      7.Value of annuity –If using 3.5, 6, or 10%, or if variable rate and period
      payout is at end of period, calculationLineis 4. .x.Line. . . .5.x. .Line. . .6. . . . . . . . . . .$
      If using variable rate and period payout is at beginning of period, calculation is
      (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

      NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of
      the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return.
                                    If more space is needed, use additional sheets of the same size.
      Reset Entire Form                                                                                    RETURN TO TOP    PRINT FORM






PDF file checksum: 4205873591

(Plugin #1/8.13/12.0)