HomeMy WebLinkAbout10-14-14 REV-1500 EX (02-11)(FI) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 1 1 0 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
0 9 2 6 2 0 1 2 0 6 1 0 1 9 2 6
Decedent's Last Name Suffix Decedent's First Name MI
PETERS JR BENJAIM I N S
(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
FILL IN APPROPRIATE OVALS BELOW
1.Original Return O 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)
❑X 6. Decedent Died Testate R 7. Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
R 9. Litigation Proceeds Received F—] 10.Spousal Poverty Credit(Date of Death 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
K E N D R A A M O H R E S Q 7 1 7 9 4 4 1 3 3 3
REGISTER OF WILLS USE ONLY
First Line of Address r-1.)
PAN N E BA K E R & MOHR P C . 3z , cz, rn
Second Line of Address c� n O
T n " 11 to
4 0 0 0 V I N E S T S U I T E 1 0 1 n
City or Post Office State ZIP Code DATA�f�'E
C) C'a -b zJ CJ
M I D D L E T OWN PA 1 7 0 5 7 .; _ `� -11 ,-';
Correspondent's e-mail address: KENDRA(QPANNEBAKERLAW.COM cin o
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.
SIGNATURE OF E SON ES SIBLE R FILI G RETURN DAT
ro q 14
ADDRESS
930 Dennis Cir Harrisburg PA 17111
SIGNATURE OF PRE A E TH REPRESENTATIVE 10 DAT
ADDRESS
4000 Vine St, Suite 101 Middletown PA 17057
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
Ir
1505610240
. 'REV-1500 EX(FI)
RECAPITULATION
1. Real Estate(Schedule A) .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . 1. .
2. Stocks and Bonds(Schedule B) . . . . . . . . . . .. . . . . . . . .. .. . . . . . . . . . . . . . . . 2. +
3. Closely 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 2 1 7 6 8 . 2 9
p p rty(Schedule E). .. . . .,. _5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . .. . 6.
7. inter-Vivos Transfers&Miscellaneous Non-Probate,Property,,
(Schedule G) ❑'Separate Billing Requested .. .. .... 7.
8. Total Gross Assets(total Lines 1 through 7) .... .. , ..., 8, 2 1' 7 6 8 , 2 9
�
9. Funeral Expenses and Administrative Costs(Schedule H) .. . . . . . . . . .... . . . . 9. 5 0 0 9 4 • 8 1
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . .. . 10.
11. Total Deductions(total'Lines 9 and`10) $. . .`.t'. ' ` i " ' : . . 11. 5 0 0 9 4 . 8 1
12. Net Value of,,Estate,(Line 8 minus Line,1.1) ..,.
. .. 12. - 2 .8 3 .2 6 ..5 2
, f .. ..��. � ,..i..�� ��rt+ .�� a "'� •� �' '''.t. `'iti.;t .
13. "Charitable`and Governmental Bequests/Sec 9113 Trusts for which `
an election to tax has not been made(Schedule J) ....... .............. .. 13.
14. Net Valu �... ,
Value Subject to Tax,(Line 12 minus 3 2 6" .. . ....... . . .. . . . . . 14. - . 5 2
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable.
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 _ 0 . 0 0 15. 0, 0 0
16. .Amount of Line 14 taxable
at lineal rate x.045. 2 8 3 26 . 5 2 16, - 1 2 7 4 . 6 9
17. Amount of Line 14taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable p
at collateral rate X.15 4. 0..Y('�'3,OT_
{^ 1$. L 0 . Q ..0
19. TAX DUE . . . . . . . .. .. . . ... .. .. . . .. . . . . . . .. . . . . . . . ... . . . . ....`.j :^ 19. - . 1 2 7 4... 6. 9.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUNDOF AN OVERPAYMENT Q
1
Side 2
1505610240 1505610240
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 12 1101
DECEDENT'S NAME
BENJAMIN S. PETERS, JR
STREET ADDRESS
3814 LAMP POST LN
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) -1,274.69
2. Credits/Payments
A.Prior Payments 22,262.59
B.Discount
Total Credits(A+B) (2) 22,262.59
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 1,274.69
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 ...................................................................... ❑ 21
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ X❑
c. retain a reversionary interest ..................................................................................................... ❑
FRI
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... El ER3. 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 designation?.................................................................................................. ❑X ❑
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 orfor 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in p2 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
BENJAMIN S. PETERS JR 21 12 1101
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. EMERGENCY ASSISTANCE PLUS PROGRAM- REFUND OF INSURANCE 62.79
2. PROCEEDS FROM PERSONAL PROPERTY AUCTION 21,705.50
TOTAL(Also enter on Line 5,Recapitulation) $ 21 768.29
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BENJAMIN S. PETERS JR 21 12 1101
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) JENNIFER GOODYEAR 18,890.48
Street Address 930 DENNIS CIR
City HARRISBURG State PA ZIP 17111
Year(s)Commission Paid: 2014, 2015
2. Attorney Fees: PAN NEBAKE R& MOHR, P.C. 326.52
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 Fees:
6. Tax Return Preparer Fees: FIDUCIARY INCOME TAX RETURNS 500.00
7. REGISTER OF WILLS-ADDITIONAL PROBATE AND FILING FEES 180.00
8. MICHAEL LANGAN, TREASURER-3814 LAMP POST LN REAL ESTATE TAXES 2,005.36
9. JANET L. MILLER, TAX COLLECTOR-3025 COLUMBIA AVE REAL ESTATE TAXES 1,941.29
10. ERIC MORROW- LAWN CARE- 3814 LAMP POST LN 1,665.00
11. PA AMERICAN WATER 315.02
12. AMERICAN MODERN SELECT INS. CO.- HOMEOWNERS INSURANCE 3,178.00
13. HAMPDEN TWP-SEWER/TRASH 635.71
14 PPL ELECTRIC UTILITIES- 3814 LAMP POST LN 976.50
15 BOROUGH OF CAMP HILL- SEWER 825.00
16. COMCAST- PHONE LINE NECESSARY FOR SECURITY SYSTEM 537.78
17. VECTOR SECURITY 503.54
18. PENN WASTE 565.01
TOTAL(Also enter on Line 9,Recapitulation) $ 50,094.81
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
BENJAMIN S. PETERS, JR 21 12 1101
Decedent's Name Page 1 File Number
Schedule H - Funeral Expenses &Administrative Costs -137.
ITEM
NUMBER DESCRIPTION AMOUNT
19. REPUBLIC SERVICES- DUMPSTER 927.44
20. PA DEPARTMENT OF REVENUE- FIDUCIARY INCOME TAX 44.00
21. LEFFLER ENERGY- FURNACE SERVICE 1,620.00
22. LEFFLER ENERGY- OIL 2,104.45
23. LEFFLER ENERGY- NEW FURNACE 2,825.00
24. CITIZENS BANK- CHECK ORDER 47.44
25. CHRIS BURROWS- SNOW REMOVAL 500.00
26. JENNIFER GOODYEAR- REIMBURSE BATTERIES FOR SECURITY SYSTEM 16.95
27. MICHAEL LANGAN, TAX COLLECTOR-3814 LAMP POST LN REAL ESTATE TAX 573.89
28. TAX CLAIM BUREAU- REAL ESTATE TAX 3025 COLUMBIA AVE 899.23
29. CITIZENS BANK FEE FOR CASHIER'S CHECK 10.00
30. JOHN JUNGREN- REIMBURSE EXPENSES 3025 COLUMBIA AVE 72.33
31. DONEGAL INSURANCE GROU- HOMEOWNERS INSURANCE- COLUMBIA AVE 656.00
32. DIANE NEIPER, TAX COLLECTOR- REAL ESTATE TAX COLUMBIA AVE 806.68
33. JENNIFER GOODYEAR- REIMBURSE AUCTION EXPENSES 359.37
34 JOHN JUNGREN- REIMBURSE LAWN CARE EXPENSE COLUMBIA AVE 63.86
35. SHORT CERTIFICATES 10.00
36. POSTAGE 8.82
37. DIANE NEIPER, TAX COLLECTOR- REAL ESTATE TAX COLUMBIA AVE 2,029.06
38. SAMANTHA GOODYEAR-AUCTION PREPARATION 546.00
39. JOSHUA GOODYEAR-AUCTION PREPARATION 602.00
40. TERRY GOODYEAR-AUCTION PREPARATION 378.00
41. CITIZENS BANK- CHECK ORDER 51.66
42. SALE OF 3814 LAMP POST LN- NOTARY FEE 10.00
43. SALE OF 3814 LAMP POST LN-TAX CERTIFICATION FEE 10.00
44. SALE OF 3814 LAMP POST LN- REALTY TRANFER TAX 1,650.00
45. SALE OF 3814 LAMP POST LN- HAMPDEN TWP SEWER AUTHORITY 101.46
47. SALE OF 3814 LAMP POST LN- REAL ESTATE TAXES 76.96
48. SUPPLEMENTAL INHERITANCE TAX RETURN AND INVENTORY FILING FEES 30.00
49. PA DEPARTMENT OF REVENUE- FIDUCIARY INCOME TAX DUE 19.00
SUBTOTAL SCHEDULE H-137 17,049.60
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BENJAMIN S. PETERS JR 21 12 1101
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. JENNIE GOODYEAR Lineal
930 DENNIS CIR
HARRISBURG, PA 17111
2. ESTATE OF STEVEN BORDNER Lineal S� 9p
C/O DZMM, 635 N. 12TH ST, SUITE 101
LEMOYNE, PA 17043
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 AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
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FOREVER
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CONFIDENTIAL
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
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AND MOH& P.C. C!
LAW OFFICE OF
PANNEBAKER & MOHR, P.c.
4000 VINE STREET,SUITE 101
MIDDLETOWN,PA 17057
KENDRA A.MOHR Telephone: 717.944.1333
email:kendra@pannebakerlaw.com Fax: 717.944.4004
October 9, 2014
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Benjamin S. Peters,Jr.
No. 2012-01101
Dear Sir or Madam:
I have enclosed a Supplemental Inheritance Tax Return and Supplemental
Inventory to be filed in the above-captioned Estate. I have also enclosed a check in the
amount of$30 for the filing fee. Please time stamp the extra copy of each document and
return them to me in the enclosed envelope.
Thank you for your attention to this matter. If you have any questions, please do
not hesitate to contact me.
Sincerely yours,
Kendra A. Mohr
Enclosures
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