Pennsylvania Schedule C-SB - Small Business Exemption

Schedule C-SB - Small Business Exemption
Schedule C-SB - Qualified Family-Owned Business Exemption (REV-571)
(EX+) MOD 04-19 (FI)

REV-571

Bureau of IndIvIdual Taxes
Po Box 280601
HarrIsBurg Pa 17128-0601

SCHEDULE C-SB
QUALIFIED FAMILY-OWNED
BUSINESS EXEMPTION

ESTATE OF:

FILE NUMBER:

This schedule may be used only by estates of decedents dying on or after July 1, 2013.
Use this schedule to report a business interest for which you claim an exemption from inheritance tax
under the qualified family-owned business exemption (72 P.S. §9111(t)).
Provide the following information in addition to Schedule C-SB. Failure to provide the following
information may result in a denial of the exemption or a delay in processing.
• Attach a written statement explaining in detail how the business interest qualifies for the exemption.
• Attach all documents supporting the written statement, including the valuation of the net book value and
business balance sheet.
SECTION I

BUSINESS INFORMATION

Business Name

Date Established MM/DD/YYYY

Business EIN

Number of Employees

Street Address
Net Book Value

City
State

SECTION II

ZIP Code

Value at Date of Death (Under 72 P.S. § 9121)

OWNER INFORMATION

Provide the name and mailing address of all transferees of the business interest identified above (attach additional
sheets if necessary):
Owner Name
Mailing Address
City
Phone Number

State

ZIP Code

Relationship to Decedent

Owner Name
Mailing Address
City
Phone Number

State

ZIP Code

Relationship to Decedent

Owner Name
Mailing Address
City
Phone Number

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State

ZIP Code

Relationship to Decedent

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Pennsylvania Department of Revenue

Instructions for REV-571

schedule C-sB – Qualified family-owned Business exemption

rev-571 In (ex) 04-19

GENERAL INFORMATION

SECTION I

PURPOSE OF SCHEDULE
Use REV-571, Schedule C-SB to report a business interest
for which you claim an exemption from inheritance tax
under the qualified family-owned business exemption.

BUSINESS INFORMATION
Provide the business name, business EIN, date business
was established, the physical location of the business,
number of employees, net book value and the fair market
date of death value of the interest that qualifies for the family-owned business exemption.

NOTE: REV-571, Schedule C-SB must accompany
the return if a business interest qualifies for the
family-owned business exemption. All information supporting the qualifications of the business interest for the
claimed exemption must be presented with the return
along with a written statement explaining in detail how the
business interest qualifies for the claimed exemption.

FORM INSTRUCTIONS
ESTATE OF
Enter the complete name of the estate as shown on REV1500, Pennsylvania Inheritance Tax Return.
FILE NUMBER
Enter the file number of the estate assigned by the Register
of Wills as shown on REV-1500, Pennsylvania Inheritance
Tax Return.

GENERAL INSTRUCTIONS
IMPORTANT: This Schedule is appropriate only for
estates of decedents dying on or after July 1, 2013.

www.revenue.pa.gov
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Date Established: Indicate the exact date the business
entity was established.
Number of Employees: List the number of full-time equivalent employees employed by the business on the date of
death.
Net Book Value: List the net book value of assets of the
business on the date of death. Attach copies of supporting
documents.
Date of Death Value: Provide the fair market value of the
business interest on the date of death.

SECTION II
OWNER INFORMATION
Provide the name, address, phone number and relationship to the decedent of all transferees of the business interest which qualifies for the family-owned business exemption. The mailing address will be used by the department to
send an annual certification form to verify compliance with
the requirements of the qualified family-owned business
exemption.

REV-571
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