HomeMy WebLinkAbout09-15-14 (5) J 15Q561014�
REV-1500 �` �°�-"'`f''
OFFICIAL USE ONLY
PA Departrnerrt of Revenue �p�y�pde Year Fle Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 2soso� 2 1 1 4 0 0 6 1
Harrisbu� PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Soc�al Security Number Date of Death NMADDwvY Date of Birth MMOOVYw
1 0 ? 1 9 2 0 1 3 0 9 2 7 1 9 3 4
DecedenYs Last Name . Su�x . DecedenYs First Name . M� •
B e n s o n J e a n n e M
(If ApplicaWe)Errter Surviving Spouse's Intortnation Below
Spouse's Last Nams S��tfix Spouse's First Name M� .
Spouse's Social Security Number
THIS RETURN MUST BE FILED iN DUPLICATE WITH THE
, REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
"Q- 1.Griginal Retum � 2.Supplemental Retum � 3.Remainder Retum(Date of Death
Priorto 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum 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.Litk�ation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � 11.Election to Tax under See.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTUU.TAX INFORMATION SNWLD BE DIREC7ED TQ:
Name Daytime Telephone Number Q '•
S t e p h e n J • H o g g � E s q • 7 1 7 � � 5 � �8�
REGIS �L�.LS U NLY� �
�I% +_`J � � �-+ R} Cr1
First Line of Address . ° �';, ",•�.F •� � �
: E-� rJ
1 9 S • H a n o v e r S t r e e t , � =� �
+ � �
Second Line of Address �
�
� S t e • 1 0 1 � �
City Ot POSt Office
State ZIP Code -" DATE FIIED� �
C a r 1 i s 1 e P A 1 7 0 1 3
..onespondenYs e-maii address:
schedules and staternents.and to the best of my knowledpe and belieF,
Under penalties of perjury,I dedare lhat i have examined this retum,indudinplaxompan�'s��aB information of which preparer hae arry knaYVledge.
R fs We,cortect and canplete.Dedaretion of preparer other than the persona represe
SIGNA RE OF PERSO ESPON ISI.E FOR FILING RECURN ��
�� �
�(Jl,�,�
nooRess Sterlin VA 2a165
47457 Mi , luff Place
SIGNATURE OF H R N RESENTATNE . 9 j��t
ADORESS� P A 17 013
19 S- Hanover S t, Ste• 101 Carlisle
PLEASE USE ORIGINAL FORM ONLY
Side 1
�
150561014D 150561D140 „�
. __ _
� 1505610240
REV-1500 EX(FI) pecedenYs Social Security Number
o��rSNa�: Jeanne M- Benson 1 8 1 2 8 2 8 8 6
�caPRUwnoN
1. Real Estate(Schedule A) ........................................... 1• •
2. Stocks and Bonds(Schedule B) ..........................•............ 2. . - �
3. Closey Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. •
4. Mortgages and Notes Receivable(Schedule D) .......................... 4. •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 7 3 9 6 4 6. 3 7
6. JanUy Owned PropeRy(Schedule� ❑ Separate 8itling Requested....... 6. 2 3 8 1 5. 1 5
7. Inter-Ynos Transfers&Miscellaneous N Probate Property D , � O
(Schedule G) - � Separate Siiling Requested....... 7.
8. Total Gross Assets(total Lines 1 through 7) ........................... 8. 7 6 3 4 6 1. 5 2
9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9• 1 5 6 � 4 . 0 4
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) ............. 10. 6 4 2 1. 4 8
11. Total Deductions(total Lines 9 and 10) ...................•••......... 11. 2 2 0 2 5. 5 2
12. Net Value of Estate(Line 8 minus Line 11) ............................ 12• 7 4 Z 4 3 6 . 0 0
13. Charitabte and Govemmental BequestslSec 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. 7 4 1 4 3 6 . 0 D
TAX CALCULATtON-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxeble
at the spousal tax rate,or
transfers under Sec.9116
(a?(1.2)X.0 _ . 15. .
16. Amourrt of Line 14 taxabie
at lineal rate X.045 7 4 1 4 3 6 . 0 0 �6. 3 3 3 6' 4 . 6 2
17. Amount of Liae 14 taxable �
at sibling rate X.12 . 17. •
18. Amount of line 14 taxable
at ootla6erai rate X.15 • �a• '
19. TAX DUE .......................................... ............ 19. 3 3 3 6 4 . 6 2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
L 150561024� 1505610240 �
REV-1500 EX(FI) Page 3 Flle Num6er
Decedent's Complete Address: 2� 14 oos�
DECEDENTS NAME
Jeanne M. Benson
STREETADDRESS
C� �A� ZIP
Tax Payments and Credits;
1• Tax Due(Page 2,Line 19} (1) 33.364.62
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+g) �2� 0.00
3. Interest
!3) 407.64
4. If Line 2 is greater than Line 1+Une 3,enter the difference.This is the QVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. {4) 0.00
5. If Line 1+Une 3 is greater than Line 2,enter the drfFerence.This is the TAX DUE (5) 33.772.26
Make check payabie to: REGISTER OF WILLS, AGENT
. . .
._ .,
. . - .. . . .. , , 9 � . � -.. .... ,. .__ .. . . . �. .. . . .. . . . .
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIA'fE BLOCKS
1. Did decedent make a transf�and: Yes No
a. retain the use or income of the property Uansferred ...................................................................... ❑ ❑
b. retain the right to designate who shall use the PropertY transferred or its income ............................... 0 ❑
c. retain a reversianary interest ..................................................................................................... ❑ ❑
d. reoeive the promise for life d either payments�benef'Rs or care? ....................................................... ❑ ❑
2. If death oa:urred after December 12,1982,did decedent transfer property wittiin one year of death
wfthout receiving adequate consi�ration? ....................................................................................... ❑ ❑
3. Did dec�ent own an'in tn�st for'or payable-upon�eath bank account or security at his or her death? ......... ❑ ❑
4. Did decedent own an individual retirement�count,annuity or other non-probate property,which
c�tains 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.
. . . .. .
For dates of�aih 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
is 3 peroent(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 ihe use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(6)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for discbsure of assets and
filing a tax retum are still appticable even if the surviving spouse is the only beneficiary.
For dates af 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 p2 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for ihe use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in p2 p.s.§s��s�aKt}�.
• 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 bbod or adoption.
; , , �.,,��. �: �w . �:,� ��,-.�,��.-��. .� .�.-:. �,.�,w� >-, �,�.��-�. �.,� , _.._
REV-1508 IX+(OB-12) �
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8 MISC.
INHERffANCE TAX RETURN
�sioErrroECe�rir • PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Jeanne M. Benson 21 14 0061
Include the proceeds of litigatioo and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Capital One Bank Money Market Account Number 8450 �g,207,98
2. KeyBank Money Market Checking Account tVumber 327150022777 75.61
3. PenFed Credit Union Account Number 2-03-3 2,102.09
4. PenFed Credit Union Account Number 5-01-7 146.45
5. Fidelity Acx�ount Number 2AS745677 26,73221
6. Morgan Stanley 580,840.78
7. Morgan Stanley 14,220.00
8. Hartford Annuity 56,645.68
9. MetLife 39,675.57
TOTAL(Also enter on Line 5,Recapitulation) S 739 646.37
If more space is needed,use additiona!sheets of paper of the same size.
;��.�,.,,�.�.���:�;���.-�--��,��� M�..�`�' ,,� �. ._ .
Rew��Ex+�o�-�o� � � .
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY �
INHERITANCE TAX RETURN
RESIDENT DECEpEDfi
ESTATE OF: FILE Ni1MBER:
Jeanne M. Benson 21 14 0061
If an asset vvas made joiMiy owned within one year of the decedenYs date of deafh,it must be reported on Schedule G.
SURVMNG JO1NT TENANT(S)NAME(Sj ADDRESS RELATIONSHIP TO DECEDENT
�a.Dawn Sharp 47457 Middle Bluff Place daughter
Sterling VA 20165
�.
C.
JOINTLY-OWNED PROPERTY:
LEITER DATE DESCPoPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FlNANCL4L INST(TUTION AND BANK ACCOt1NT NUMBER OR SIMILAR DATE OF DEA7H DECEDENTS VALUE OF
NUMBER 7ENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTIY-HELD REAL ESTATE. VALUE OF ASSET fNTEREST DECEDENTS INTERFST
1. A. M8T Bank Checking Account#9849867487 47,630.29 50. 23,815.15
i �
TOTAL(Also enter on Line 6,Recapitulation) f 23 g15.15
If mor�e space is needed,use additional sheets of paper of the same size.
REV 7511 EX+(pg-13) �
pennsytvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jeanne M. Benson 21 14 0061
DecedeM's debls must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezii Funerat Home 3,350.00
2. Flowers for Church 200.00
3. Church Reception 200.00
B• ADMINISTRATtVE COSTS:
1• Personal Representadve Commissions:
Name(s)ofPersonalRepreser�tive(s) Dawn Sharp 5,000.00
StreetAddress 47457 Middle Bluff Place
��y Sterlin4 �� VA zfP 20165 -
Yea�(s)Commissior�Paid:
2, atmmeyFees: Stephen J. Hogg, Esquire 4,000.00
3. Fartry Exe�►�ption:(It deoedenCs address's not the same as daimam's,attach explanation.)
ClaimaM
SUeetAddress
�!' Stabe ZIP
Relationship of Claimant to Deoederrt
4� Probate Fees: 308.50
5. AcoourHant Fces
6. Tax Reh�m Preparcr Fee�
7. Advertising: Sentinef 190_54
' Cumberland Law Joumal 75.00
8. Accounting 200.00
� 9. . Tax Retum and Inventory F.ee � . � . � 30.00_
10. Short Certificates 15.00
11. Bond Filing Fee 15.00
12. Bond Fee 2,020.00
TOTAL(Also enter on Line 9,Recaptulation) S 15 604.04
If more spaoe�needed,use addlUonal st�eefs of paper of the same size.
���,,��.:�.���r: -�,.��Y�. ;.� ,,.
REV-1512 EX+(12-12) .
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERfTANCETAXRETURN MORTGAGE LIABILITIES 8 LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jeanne M. Benson 21 14 0061
Report debts incumed by the decedent prior to death that remained unpaid at the date of death,including unrcimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRlPTION OF DEATH
1. Refund Direct Deposit(SSA) 1,372.00
2. Uhaul Truck Rsntal 401.93
3. CitiBank • 33.04
4. Moving expenses 300.00
5. CitiBank 11.50
6. Diamond Pharmacy 126.52
7. Labor expenses for moving out of Country Meadows 360.00
8. All Better Care 20.00
9. Pennsylvania Department of Revenue 877.00
10. Reimbursement out of pocket expense for hospital needs 140.84
11. PFCU 17,g�
�2. FIA 33.85
13. United States Treasury 2,727.00
TOTAL;Also ente.r on Line 10,Recapituladonj S 6 421.48
If more space is needed,insert additional sheets of the same s'ize.
REV-5513 EX+(01-10) �
pennsylvania SCI-IEDUL� .1
DEPARTMENT OF REVENUE
ir,�+Ewr,wce rnx�ruw� BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF: FILE NUMBER
Jeanne M. Benson 21 14 0061
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not Lfst Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [Include outrigM spousal distriM�ions and transfers under
Sec.9116(a)(1.2).]
1. Dawn B.Sharp Lineal
47457 Middle Bluff Place
Sterting,VA 20165
2. Julie A. Benson Lineal
59 Warwick Circle �
Mechanicsburg, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE ANO GOVERNMENTAL DISTR►BUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CCVf R SHEET. S
If more space is needed,use addidonal sheets of paper of the same size.