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Home My WebLink About08-25-11 (2)~ i REV-7500 EX + (6-00) COMMONWEALTH OF REV-15 0 0 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) F- Z BENEDICK, ALBERT E. LJ.I DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 0 W IU 03/26/2011 10/09/1918 Q (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NONE a X^ 1. Original Return ^ 2. Supplemental Return N o ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of deatn after 12-12-82) v a m XD 6. Decedent Died Testate (Attaon copy of will) ^ 7, Decedent Maintained a Living Trust (Attaon copy of rr~st) a a ^ 9. Litigation Proceeds Received ^ 1 O. SpOUSaI POVerty Credlt (date o(death between 12-31-91 and 1-1-95) I- z w 0 z 0 a w 0 U OFFICIAL USE ONLY FILE NUMBER ~~ I COUNN ~""c _ YEAR ,• / 1 N~ n R SOCIAL SECURITY NUMBERS _ MBE _1 8 8- 0 3- 3 5 9 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attacn son o) I rns Jtl: l IUN MUST 6E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS CHARLES J. DEHART, III, ESQUIRE 3631 NORTH FRONT STREET FIRM NAME (If Applicable) CALDWELL & KEARNS TELEPHONE NUMBER 717-232-7661 HARRISBURG PA 17110 Q _N O. U w 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 190.45 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 91, 954.57 ^ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) $5 987.06 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13, 504.45 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 187.50 11. Total Deducfions (total Lines 9 & 10) (11) _ 13,691.95 12. Net Value of Estate (Line 8 minus Line 11) (12) _ 164,440.13 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 164,440.13 Z _~ H Q 0 U X SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 0.00 x (15) 0 00 . 164,440.13 x .045 (16) 7 399 81 , . 0.00 x 12 (17) 0 00 . . 0.00 x 15 (18) 0 00 . . 19. Tax Due (19) 7,399.81 20. ^ • ~- - ~ . - ~ • • -•~ OFFICIAL USE ONLY . f j y L~.,,-~ ~ ~~ J .. ~ a '-:~ r..... .~ - r-r1 ~; ~ ~ .._ ~: ~ ~~ ~ " . :_ .. __. , ~ ...t.? r -- ~ ~ ~ _ , . - -r ! _ .,~ --. __.. , -~ c. < 178,132.08 -- ~~•~•••-~~ r-~~V ~aicvVV ~ ivi~.~ vii r~cvCr~JC .71uC HrVU KCI.I"ICI.:K MA I ti < G r Decedent's Complete Address: STREET ADDRESS 426 F Duke Street CITY Enola STATE PA zIP 17025 Tax Payments and Credits: ~ ~ Tax Due (Page 1 Line 19) (1) 7 399 81 2. CreditslPayments , . A. Spousal Poverty Credit B, Prior Payments 6 000.00 C. Discount 315 79 Total Credits (A + B + C) 3. Interest/Penalty if applicable (2) 6, 315.79 D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 084.02 A. Enter the interest on the tax due, (5A) B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1, 084.02 Make Check Payable to; REGISTER OF WILLS AGENT , PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ............ .,..,..... ............................................... ^ Q b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ Q c. retain a reversionary interest; or .............................................. ........................................................ ^ a 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 year of death without receiving adequate consideration? ............................................. ........................ ^ a .......................... 3, Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................. ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................... .......,.,,.. ............................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 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, 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. SIGNAT~E OF PERSON SPONSIBLE FOR FILING RETURN DATE ~. -~ _ ~ 1 ~ _ - r, ADDRESS 426 F DUKE ST T ENOLA PA 17025 SIGNATURE OF P EPARER OTHER THAN REPRESENTATIVE DATE ~- ~ ~~l ~~ ADDRESS 3631 ORTH FRONT STREET HARRISBURG PA 17110 For 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 or for 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 the surviving spouse is 0% [72 P,S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only 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 for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S. §9116(a)(1.2)J. 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 as noted in 72 P,S. §9116(1.2) [72 P.S. §9116(x)(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(x)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. } REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN ncn[+nu w ~ nn~n~-r.~r~~ ~ IL.G 17VIYI~GR BENEDICK, ALBERT E. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Capital Blue Cross -Premium Refund 33.80 2. I Country Meadows Associates -Refund I 10.80 3. I Pension Check for March, 2011 I 142.60 4. Ilnsurance Unearned Premium Refund I 3.25 5. I Household Goods/Furnishings -None -Country Meadows Nursing Home TOTAL (Also enter on line 5, Recapitulation) I $ 190.45 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER BENEDICK ALBERT E. If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT F LPtt~ - A. ay o elger B c 426 F Duke Street Enola, PA 17025 Daughter JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE OF JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1979 Fulton Bank Account #0007-30467 2,436.05 50. 1 218.03 (See attached statement) , 2. A. 2006 Fulton Bank Account #3623-05469 24,775.81 50. 12 387.91 (See attached statement) , 3. A. 2009 Fulton Bank Account #018-0268191 80,534.93 50. 40 267.47 (See attached statement) , 4. A. 1994 Fulton Bank Account #000-0078474 29,361.42 50. 14 680.71 (See attached statement) , 5. A. 2008 Fulton Bank Account #018-0268503 46,800.89 50. 23 400.45 (See attached statement) , TOTAL (Also enter on line 6, Recapitulation) I $ 91, 954.57 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DFl`Fr~FNT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY -- " " - ~' FILE NUMBER BENEDICK ALBERT E. This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Genworth Life Insurance Company deferred annuity - 85,987.06 100. 85,987.06 Contract #0000790120 -Beneficiaries -Fay L. Potteiger and Shirley Lucabaugh (See attached statement) TOTAL (Also enter on line 7 Recapitulation) ~ $ 85,987 06 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ca ~ H i t ur FILE NUMBER BENEDICK ALBERT E. Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1. Diehl Funeral Home -Funeral services 10,459.45 2. Funeral luncheon 525.00 B• ADMINISTRATIVE COSTS: ~ . Personal Representative's Commissions Name of Personal Representative (s) Not applicable Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip _ Year(s) Commission Paid; 2, Attorney Fees Caldwell & Kearns 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant None Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees NOne 5 Accountant's Fees 6, Tax Return Preparers Fees 7, Division of Vital Records -Death Certificate 8. Register of Wills -Filing Fee 9. Miscellaneous Expenses TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) J- 2,250.00 45.00 25.00 200.00 13,504.45 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER BENEDICK ALBERT E. Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VAOF DEATDHTE 1. Memorial Hospital - Unreimbursed medical 187.50 TOTAL (Also enter on line 10, Recapitulation) I $ 187 50 (If more space is needed, insert additional sheets of the same size) s REV-1513 EX + (g_nn~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES CaiHit ur ~Cni~ni~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Fay L. Potteiger 426 F Duke Street Enola, PA 17025 2. Shirley A. Lucabaugh 2517 Brady Road York, PA 17404 50% 50% ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal Lineal TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size)