BIR Form No.

1801 Page 1 of 7

(To be filled up by the BIR)

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Estate BIR Form No.

1801
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Tax Return July 2003(ENCS)

1 Date of Death (MM/DD/YYYY) 2 Amended Return? 3 No. of Sheets Attached? 4 ATC

Yes No 27 ES 010
05 13 2014

Part I Background Information

5 TIN of the Taxpayer 000 000 000 001 6 RDO 066 7 TIN of the Executor/Administrator 234 568 957 000
Code
8 Taxpayer's Name 9 Name of
Executor/Administrator
ESTATE OF DINA DY CLARO
CLARO, CLARA, DY
10 Residence of Decedent at the Time of Death 11 Registered Address
(Executor/Administrator)
SAN MARCELINO, IRIGA CITY, CAMARINES SUR
SANTA CLARA, IRIGA CITY, CAMARINES SUR
Zip Residence Address
12 Code 4431 13 Telephone No. 14 (Executor/Administrator)

15 Are you availing of tax relief under Special Law/ International Tax Treaty? Yes No If yes, specify 15A

16 Mark applicable Box Yes No Yes No

Has a Notice of
Has the estate been settled judicially?
Death been filed?
Has an extension to file return been granted? Has an extension to pay the tax been granted?

Part II Computation of Tax

Particulars Exclusive Conjugal/Communal TOTAL
(a) (b) (c)

17 Real Properties excluding Family Home ( Sch.1 ) 17A 7,254,212.88 17B 0.00 17C 7,254,212.88

18 Personal Properties ( Sch.2/3 ) 18A 1,006,712.81 18B 0.00 18C 1,006,712.81

19 Family Home ( Sch.1 ) 19A 0.00 19B 0.00 19C 0.00
20 Taxable Transfer ( Sch.4 ) 20A 0.00 20B 0.00 20C 0.00
21 GROSS ESTATE 21A 8,260,925.69 21B 0.00 21C 8,260,925.69
22 Less: Deductions (Sch.5)
Sch.5 22A 193,196.62 22B 0.00 22C 193,196.62
23 Estate after Deductions 23A 8,067,729.07 23B 0.00 23C 8,067,729.07
24 Less: Family Home 24 0.00
25 Standard Deduction equivalent to P1M 25 1,000,000.00
26 Medical Expenses not to Exceed P500,000 26 0.00
Others (specify)
27 27A 0.00

27B 0.00

28 NET ESTATE 28 7,067,729.07

29 Less: Share of Surviving Spouse (Net Conjugal Estate divided by 2) 29 0.00

30 NET TAXABLE ESTATE 30 7,067,729.07

31 ESTATE TAX DUE 31 775,159.36

32 Less: Tax Credits/Payments

32A Foreign Estate Tax Paid 32A 0.00

32B Tax Paid in Return Previously Filed, if this is an Amended Return 32B 0.00
32C Total 32C 0.00

33 Tax payable/(Overpayment)(Item 31 less Item 32C) 33 775,159.36

34 Add: Penalties
Surcharge Interest Compromise
34A 0.00 34B 0.00 34C 0.00 34D 0.00

35 Total Amount Payable 35 775,159.36

I declare, under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
36____________________________________________________ 37_____________________________________
Taxpayer/Authorized Agent Signature over Printed Name Title/Position of Signatory
______________________________________________________ _______________________________________
TIN of Tax Agent (if applicable) Tax Agent Accreditation No.(if applicable)

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Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

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DETAILS OF PROPERTY
Schedule 1 - REAL PROPERTIES
FMV whichever is higher
OCT/TCT Tax
Zonal Value (ZV) Fair Market Value
Declaration LOCATION CLASS AREA CONJUGAL EXCLUSIVE
FMV per BIR (FMV) per TD
CCT No. No. (TD)
N/A 2006021056 SAN MIGUEL, IRIGA CITY
BLDG 464 0.01 2,999,999.28 0.00 2,999,999.28

2015 2006021253 SAN MIGUEL, IRIGA CITY

AG 11940 77,610.00 1,738,464.00 0.00 1,738,464.00

3621 2006021253 SAN MIGUEL, IRIGA CITY

AG 23038 345,570.00 2,515,749.60 0.00 2,515,749.60
TOTAL 0.00 7,254,212.88

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DETAILS OF PROPERTY
Schedule 1 - FAMILY HOME
Tax
OCT/TCT Zonal Value Fair Market
Declaration No.
LOCATION CLASS AREA (ZV) Value CONJUGAL EXCLUSIVE
CCT No. FMV per BIR (FMV) per TD
(TD)

TOTAL 0.00 0.00

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PERSONAL PROPERTIES Schedule 2 - SHARES OF STOCKS

Total Fair Market Value
No. of Fair Market Value
Name of Corp. Stock Cert. No. CONJUGAL EXCLUSIVE
Shares per Share
ST. MICHAEL CORPORATION 100-2012 5000 60.00 0.00 300,000.00

TOTAL 0.00 300,000.00

Schedule 3 - OTHER PERSONAL PROPERTIES

Fair Market Value
Particulars Exclusive Conjugal/Communal
CASH- BANCO DE ORO UNIBANK- IRIGA CITY 78,526.90 0.00

CASH- BANK OF THE PHILIPPINES- NAGA CITY 378,185.91 0.00

CAR 250,000.00

TOTAL 706,712.81 0.00

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Schedule 4 - TAXABLE TRANSFERS

Fair Market Value
Particulars Exclusive Conjugal/Communal

TOTAL 0.00 0.00

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Schedule 5 - DEDUCTIONS
EXCLUSIVE CONJUGAL/COMMUNAL
Actual Funeral Expenses or 5% of gross estate whichever is lower but not to exceed P200,000.00 144,000.00 0.00
Judicial Expenses of the Testamentary or Intestate Proceedings/Administration Expenses 7,600.00 0.00
Claims against the Estate 41,596.62 0.00
Claims against Insolvent Persons 0.00 0.00
Unpaid Mortgages 0.00 0.00
Property Previously Taxed (Vanishing Deduction) 0.00 0.00
Transfers for Public Use 0.00 0.00
Others (specify) 0.00 0.00

TOTAL 193,196.62 0.00

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