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Home My WebLink About06-06-14 � 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN �l PO BOX 280601 Harrisbur9 PA 17128-0601 RESIDENT DECEDENT � I � V��,'3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYVVY Date of Birth MMDDYYYY 02112014 06301920 DecedenYs Last Name Suffix DecedenYs First Name M I BENDER SARA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule0) CORRESPONDENT- THIS SECTION MUST BE COIIAPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUL DIRECTP,�TO: Name Daytime Telephone Numbef�' � fT1 �- ` " C7 CRAIG A • HATCH, ESQ • 717 7��,�600 � ' �; �a � i. REGIST�Fi;�WttLS USE ONLYr; �� , f..i � , �- � �._ .. . P, � . _ �. � � ;-, ;.. . . .;: _� -,r First Line of Address �-' �"� .,_� � c'; C:) —r7 2109 MARKET STREET :-' `'" "� ��" _ � ►� r Second Line of Address -o ca.� N :> O City or Post Office State ZIP Code DATE FILED CAMP HILL PA 17011 CorrespondenYs e-mail address: C • H A T C H a H H G L L P • C 0 M Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knoNAedge and belief, it is true,correct and complete. Declaratio�of preparer other than the personal representati is based on all infortnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FI G R � a'/� DATE FRED W • BENDER 'P'! ADDRESS 313 GLENN ROAD , CAMP HILL, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRE�ziJT TI � DATE CRAIG A • HATCH, ESQ • � ADDRESS 2109 MARKET STREET CAMP HILL, PA 17011 LEASE USE ORIGINAL FORM ONLY Side 1 � 1505611185 OM46473.000 15�5611185 � � 1505611285 REV-1500 EX(FI) DecedenYs Social Security Number �ecedenrsrvame: BENDER SARA M RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � $� • �� 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. $0 . 0 0 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , g. $� • �0 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q $� • �� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5, $0 • 0� 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , s. $2,012 • 4 4 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. $0 • Q Q 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 $2��12 • 4 4 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. $415 • �� 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �0. $0 • �0 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , >>. $415 • 0� 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12 $]„597 • 4 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �g. $� • 0 0 14. Net Value Subject to Tax(Line 12 minus Line 13) , , , �4, $],,5 9 7 • 4 4 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 ta�ble at the spousal tax rate,or transfers under Sec.9116 (a)(�.z)x.o� $D • 00 �5. $0 • 00 16. Amount of Line 14 taxable at�inea�ratex.o� $1�597 . 44 �s. $71 • 88 17. Amount of Line 14 taxable at sibling rate X.12 $0 • �0 �7. $� • 0 0 18. Amount of Line 14 taxable at collateral rate X.15 $Q • Q� 18. $� • 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. $71 • 8 8 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 � 1505611285 1505611285 � OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Com lete Address: DECEDENTS NAME BEND R ARA M STREET ADDRESS M CITY STATE ZIP CAMP HILL PA 170117108 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) $71 • 8 8 2. Credits/Payments A. Prior Payments $� • �� B. Discount $� • �� Total Credits(A+B) (2) $� • �� 3. Interest (3) $� • �0 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) $0 • �� 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) $�1 • 8 8 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PIACING 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ � 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ❑❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which contains a beneficiary designationl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G 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[72 P.S.�9116(a)(1.1)(i)]. For dates of death on or after Jan. 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 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 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 decedenPs 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 decedenYs 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. OM4671 2.000 REV-1509 IX+(01-10) • pennsylvania SCHEDULE F DEPAR7MENTOFREVENUE INHERITANCE TAX RETURN JOINTLY OW NED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Sara M. Bender If an asset became)oiMly owned within one year of the decederrt's date of death,k must be reported on Schedule G SURV NING JOINT TB�ANf(S)NANE(S) ADDRESS R�ATIONSFAP TO DEC�B�Ii A (Bahrenburg) Mohler, Kar 79 Queen Avenue, Enola, PA 17025 Daughter B Bender, Fred W 313 Glenn Road, Camp Hill, PA 17011 Son JOINTLY OWNED PROPERTY: t�rTER Q°`� DESCRIPfION OF PFtOP9�TY %OF Q4TE OF DEATH �� FORJOINT MADE INCLUDENAAEOFFIN�NCIALINSTITVfIONANUBANKACCWMNU�.BEROR5IMUR ��F�ATM �S VALUEOF N�VBBZ TENANT .fQIN� IDENTIFVINGNUA6ER.ATTACH DEED FOR JdNTLY HELD REAL ESTATE. VAL�OF ASSET INTHZEST DEC�HIB�T�S IMBZEST 1 BA 3/1/2010 Santander Money Market Acet. No. 924087293 $1,002.78 33.3333 $334.26 2 BA 3/1/2010 Santander Checking Acct. No. 1711061042 $5,034.53 33.3334 $1,678.18 TOTAL (Also enter on Line 6, Recapitulation) S $2,012.44 swasne z.000 If more space is needed, use additional sheets of paper of the same size. , REV-1511 EX+(08-13) SCHEDULE H ' pennsylvania DEPPRTMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara M. Bender DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: �. None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: $400.00 3. Family Exemption:(If decedent's address is not the same as claimanYs,attach e�lanation.) Claimant Street Address Ciry State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Register of Wills filing fees $15.00 TOTAL(Also enter on Line 9,Recapitulation) $ $415.00 awasAC z.000 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+(Ot-10) SCHEDULE J pennsylvania DEFARTMENT OF REVENUE BEN EFIC IARI ES INHERITANCE TAX RETURN RESIDENT DECEDEM' ESTATE OF: FI�E NUMBER: Sara M. Bender RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[InGude outright spousal distributions and transfers under Sec.9116(a)(1.2).] �. Fred W. Sender 313 Glenn Road Camp Hill, PA 17011 One Half of Residue: $798.72 Son $798,72 2 Karen L. (Bahrenburg) Mohler 79 Queen Avenue Enola, PA 17025 One Half of Residue: $798.72 Daughter $798.72 ENTER DOLLAR AMOUNTS FOR DISTRIBUiIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NOh�-TAXABLE DISTRIBUTIONS A.SPOUSA�DISTRIBU110NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: t. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S $0.00 9 W46AI 2.000 If more space is needed,use additional sheets of paper of the same size. DEATH CERTIFICATE ;� �� PA REV-1500 SCHEDULE F JOINTLY OWNED PROPERTY � Checks Posted Cheek�f Date Paid Amount Reference Check�! Date Raid Amount Reference ; 53�'F ': #I1f37 �37 5� > �9�14q�4St# 5175 02/11 55,000.00 0970175990 5173* O1/30 317.36 0980805370 x17fi t32f13:.: ;;. ��5�0; > Q9�98��&2SS: <E 59��$..: . i1��$ .:; ,:$�5 5S ` V�;f3l��hk�tN�#�1Gt�t�?_ 57 77 02/19 860.00 09717641 15 6 Check(s)Posted=55,165.41 An asterisk(*)indicates a skip in sequential check numbers. An(E)indicates check was converted to an electronic item AtCOUtlt ACt1Vit�/ Date Description �4dditions Subtradions Balance 01-22 8e innin Balance 48,223 94 ' 0't 28::: ��C1t�d FiMAt�f°t�'�3'i?:Y�N'�'S�A�S��:�`5��+� : ;: >�� :: ... $.��18 39::. 01-30 CHECK OOOOOOt)05173 $1736 $8,181.03 ';0#,3fi;:<. 7L'�'.E:��E�ASUR�! �'(C�X1C�1�sT�£:AtE (}13i�1+��*r*;�ar*� ; .��,�:::�4n . :> ;:. <::. '��,�lt�.>: , #:E�##3, , ,:, 01-31 CNECK OOOOODU05171 $37.50 $9,273 53 :;02-b�: : �5�4.�t�A��3�it�.C�E�'i�2[�314*�r,��,�*«*�p . .. .;. _ 3��3. ...'� .. ....:: :: ... . $>FU.l�3�;?5:�;< 02-11 CHECK OOOOOOQ0517� ,, _ _ _ _...,_ �S(x,. $5,000.00 55,034.53 , � ' ;..fl�1�':: . �I-iECI�:�i��Diil�'r1:�6 ;_ :: � : _ ': .: <: . ;- �2�t�: ... _.. ...'r�' .. � ! 02-19 CHECK 000000005177 $60.00 $4,949.53 , � ;>t3�� : ��ER��T ... aiT�3�C]!�.flt1�fY�2fl"E�l t�;0�}99I��1i� ' , S;t�E3� .. ; +,� :��9:6�:: . . . _ 02-21 Ending Salance $4,949 6U � � * � � . . ._ •. � , � � , SARA M BENDER Account#924087293 FREG :YBENQER KAREN L BAHRENBURG Balances , _.. . ;:�. �Sn�� .�ala�. `: #'�.�t5,2�8 :;,��eiit.. fat��, .... -. _�.,. #�w��'� :: Deposits/Credits +80.09 Avera e Daii Balance $1,002.78 ::<1��.dt�?va�IQe�i� . ' >: . ��tt� ::: ., . Interest ,��atl#ft�.Per�d."::. ` ... ::�tl.?I#�....: �!Xtz�4t�?.... ..'�!'►��E,��f'_:. .. ��9b�:: . . , � .... . .............. . . .. ... ....... .. . ... Earned this Period $0.08 Paid Last Year $135 ... , „ ; ;. P�+d.Y�r Tr�€�a'� : ..:: .. . : ,3�.17 :._ . ' ' - ., ..... .,... : , - *The interest earned and the ir.terest paid may differ depending on when interest is credited to your account. Account activity Date Description Additions Subtractions Baiance Oi-22 Beginoing Batance $1,002.78 OZ 2� .;:: fit�T'�RE�.�1�;t�3 f ft�3�l�!f1�1Zk1}2�'E�f�'Q:t1��79/��9� . ': �61�5 ;: . '; .��,D�� ;' ��; 02 21 Ending Balance $1,002.87 `� �** END OF ATTACHMENTS ***