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HomeMy WebLinkAbout04-23-14 (2) REV-1500 Ex(D2-11) 'j{: 1505610143 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY P pennsyivania County Code Year File Number Bureau of Individual Taxes PO BOX,280601 INHERITANCE TAX RETURN 21 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 12 2014 10 22 1938 Decedent's Last Name Suffix Decedent's First Name MI BENDER GENE R (if Applicable)Enter Surviving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS r,FILL IN APPROPRIATE OVALS BELOW CJ f. Original Return LJ 2. Supplemental Return 3, Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Future Interest Compromiae 5. Federal Estate Tax Return Required (dale of death after 12.12-821 Cl 6. Decedent Died Testate 7. Alta eCopy oJVnes)a Wine Trusi Q, Q. Total Number o(Safe Deposit Boxes J (Attach Copy of NAll) 9, Litigation Proceeds Received L� 10.Geiweeni23i�a�i ena><Da95MDeeth 11.Election t0 tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED-ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 761 45" � m p c-, REGISTER la WILLS US�LY2 z w� First Line of Address �rr— y m W i. n d X, co 301 MARKET STREET o --a ` °n Second Line of Address "�1 ty PO BOX 109 ::0 ~ FILED I.-' �1 City or Post Office State ZIP Code D LEMOYNE PA 17043 Correspondent's e-mail address: eamAidsw corn 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, n 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 OP A RSO R SRONSIeLE FOR FUNG RETURN w DATE a4 Lois Lois Sullivan -�i�`2 ADDRESS 209 Orchard Street Mechanicsburg PA 17055 SIGNA OF PREPAREft OTHER THAN REPRESENTATIVE. DATE Edmund G. Myersf 2Lrr y ADDRESS 301 MARKET STREET Lemoyne PA Side 1 1505610143 1505610143 ��' J 1505610243 REV-1500 EX °aoetlent's"ame. Bender, Gene Raymond Decedent's Social Security Number RECAPITULATION 1. Real Estate(Schedule A)....................................................... 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 7 , 734 . 25 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous {oq-Probate Property I (Schedule G) LJ Separate Billing Requested............ 7, 8. Total Gross Assets(total Lines 1 through 7)............................... a. 7 , 734 . 25 9. Funeral Expenses and Administrative Costs(Schedule H)............ s. 4 , 362 . 50 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 749 . 45 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 5, 111 . 95 12. Net Value of Estate(Line 8 minus Line 11)............................. .... . 12. 2 , 622 . 30 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14, Net Value Subject to Tax(Line 12 minus Line 13)....................... 14. 2 , 622 . 30 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 (a)(1.2)X .00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate .12 2 , 622 . 30 17. 314 . 68 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18, 0 . 00 19. TAX DUE................................................................................................................. 19. 314 . 68 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ L. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Fite Number 21 Decedent's Complete Address: DECEDENT'S NAME _ Bender, Gene Raymond STREET ADDRESS 209 Orchard Orchard Street CITY--`------i.— STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 314.68 2. Credits/Payments A. Prior Payments B. Discount 15.73 `i Total Credits(A +B) (2) 15.73 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 2e to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 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;.._........................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income;.................................. [] c. retain a reversionary interest;oc....._..........................................---........._....---................................... d, receive the promise for life of either payments,benefits or care?............................................................ z. 2. if death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?,...--­­-..........-........ .............. ❑ ��r''' 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ u 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...................................... ............._........—............................................... .. ❑ Exi IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE O AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent 172 P.S.§9116(a)(11)Ili], 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 percent (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 4 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 21 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 percent[72 P.S.§9116(a)(1.2)]- • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in(72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling 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-05e8 EX+(11,1 o) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Bender,Gene Raymond 21 include the proceeds of litigation and the date the proceeds were received by the estate. All property,iointlyowded with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Metro Bank Signature Checking Account No.537106767 -A copy of the Decedent's Account 7,193.02 Statement is Attached 2 Harmony Hill Nursing Home-Refund on Account 541.23 TOTAL(Also enter on Line 5,Recapitulation) 7,734.25 (If more Space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Apr 11 14 09: 39a RITTER 'S HARDWRR 1 -717-766-2491 p. 1 Signature - Servicing - BNKPRDA550 Page i of 1 Checking Account Inquiry-Current Statement 3.27.2014 OS-SerNcecharge wrhn(p9riotl � Account Numhar 53]10616 "I — Bat as of 7055 •CaWCR 0 - Sems R -Service charge0�0 -Interest paid I Oqi Opt Pst of Serial Number TC De Curtent balance F 6,631.571 Eq UI SW,A pn Amount BuO 8alan�9 J u 030414 Str(RunlBauSegp 656 081 CHECKS -1095.30 7553.02 030414 657 081 CHECKS i 030414 858 081 CHECKS -100.00 7453.02 i 030414 -120.00 7333.02 • ' 659 061 CHECKS -140.00 7193.02 ,O./C -4 Dp( f7.. 035314 660 081 CHECKS -011?5 l�"t r I 032014 6781.67 661 081 CHECKS -250.00 653157 LL httn //1 n 'MO 77 6l1-47nl7/A 1 .Qlrrnl H"1 REV-1511 EX.110-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE RETURN RESIDENT DENTDECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Bender, Gene Raymond 21 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 3,612.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees JOHNSON DUFFIE 600.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 150.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 4,362.50 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) � . f SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Bender, Gene Raymond 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Malpezzi Funeral Home -Deposit On Funeral Services 500.00 2 Malpezzi Funeral Home -Remaining Balance 3,112.50 H-A 3,612.50 Other Administrative Costs 3 Reserves: Additional Miscellaneous Administrative Costs/Expenses 150.00 H-B7 150.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 6-98) Rev-1512 EX+(12-D8) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Bender, Gene Raymond 21 Report debts Incurred bythe decedent prior to death that remained unpaid atthe date of death,including unrelmbursed medical expense.. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Checks Clearing After Date of Death 661.45 2 VA-Prescription Medications 88.00 TOTAL(Also enter on Line 10, Recapitulation) 749.45 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1517 EX.(01-10( pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Bender, Gene Raymond 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) 0 o t a I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Barry Bender Brother 1/2 of Intestate 698 Front Street Estate-Intestate Enola, PA 17025 Beneficiary 2 Lois Sullivan Sister 112 of Intestate 209 Orchard Street Estate-Intestate Mechanicsburg, PA 17055 Beneficiary Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)