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Home My WebLink About11-01-05 f{EV.1500 EX i5-00': REV-1500 ~,. COMMONWEALTH OF *.., , PENNSYLVANIA " l"J,'~,'" DEPARTMENT OF REVENUE , . DEPT. 280601 '. 'HARRISBURG, PA 17128-0601 ~,t -- . INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U W C DECEDENT'S NilME (LAST, FIRST, AND MIDDLE INITIAL) Benner, Claire M. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 05/09/2005 12/28/1920 (IF APPLICABLE. SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) W f- >t:~(J) uD:>t: LUO-U J:oo uD:...I O-lD 0- ct ~] 1. Original Return [J 4. Limited Estate IX] 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of deall1 after 12.12.82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) FILE NUMBER ~L-.Jl.~ COUNlY CODE YEAR ..0...- A5--L UMBER SOCIAL SECURITY NUMBER 177 - 16 -f " 543 THIS RETURN MUST BE FILED IN 0, PLICATE WITH THE REGISTER OF! ILLS SOCIAL SECURITY NUMBER i I o 3. Remainder Return (date Ofo1all1 prior to 12.13.82) o 5. Federal Estate Tax Returm ,Required 8 . Total Number of Safe Dep~sit Boxes I o 11. Election to tax under Sec.19113(A) (Attach Sch 0) NAME COMPLETE MAILING ADDRESS f- Z w c z o 0- (J) LU D: D: o U Jerry A. Philpott FIRM NAME (If A Jplicable) PO Box 116 Duncannon, PA TELEPHONE NUMBER 717-834-3087 1. Real Estate (Schedule A) (1) (2) (3) (4) (5) 14,986.40 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages 8 Notes Receivable (Schedule D) z o ~ ..J :J !:: a.. ~ u w a::: Cash, Bank Jeposits & Miscellaneous Personal Property (Schedule E 6 JOintly Owmd Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos 1ransfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (6) (7) (8) 4,358.82 9. Funeral Exp'~nses & Administrative Costs (Schedule H) (9) (10) 10. Debts of Deeedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable aqd Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < I- :J a.. :E o u ~ 15. Amount of L ne 14 taxable at the spousal tax rate, or tram,fers under Sec. 9116 (a)(1.2) x .0 16, Amount of L ne 14 taxable at lineal rate x .0 17. Amount of L ne 14 taxable at sibling rate x .12 10,627.58 18. Amount of L ne 14 taxable at collateral rate x .15 19 Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 17020 " I '''If. ~t -"1"" ., .d- eb 1 4 , 98 6 .p-_______m__ (11) (12) (13) 4,358.82 10,h?7 ts .?O i 10,627.~8 I i I I I t-- (14) (15) (16) (17) (18) (19) I 1 .594 ~.~,.....".__ --.._-- 1,594 14.._ Decedent's Complete Address: STREET ADDRESS 1550 Williams Grove Road, Lot 112 CITY Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,59 .14 Total Credits (A + B + C ) (2) 1,59 .14 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 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) \, .00 I 5 If Line 1 + Line 3 is qreater than Line 2, enter the difference. This is the TAX DUE. (5) A Enter the interest on the tax due. (5A) B Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If ceath occurred after December 12, 1982, did decedent transfer property within one year of death witnout receiving adequate consideration? ............................................................................................................ 0 3. Die! decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 1,5g~_14 .00 No IX] DU IKJ [X] OCJ IKJ IXJ I I I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF fHE 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 ccmplete. . ! Declaration of preparer other thai' the personal representative IS based on alt Information of which preparer has any knowledge. ADDRESS Stephen A. Kohlhaas SiGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Enola, PA 17025 Jerry A. Philpott ADDRESS 'A 17020 or a'ter 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 spous is 3% (1.1) (i)]. For dates of dea [72 PS 99116 DATE I rj -, 7 - 05 I \ DATE 10 -~Lj- OS et value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~ 116 (a) (1.1) (ii)]. e statutory requirements for disclosure of assets and filing a tax return are still applicable even if For dates of death on or 3fter J The statute does not exerrw! a the surviving spouse is the only t For dates of death on or a'ter Jul The tax rate imposed on the net or a stepparent of the chile! is 0% The tax rate Imposed on the net 1 The tax rate imposed on the ne Individual who has at least one pl NAP/) '1-C~- ty-one years of age or younger at death to or for the use of a natural parent, a adoptive parent, nt's lineal beneficiaries is 4,5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~ 116(a)(1)]. cedent's siblings is 12% [72 P.S. s9116(a)(1.3)]. A sibling is defined, under Se lion 9102, as an .. ........_.. ...." "'V "",-""CIII, wlltllner oy blood or adoption. REV-1508 EX+ (6-981 " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES:DENT DECEDENT ESTATE OF Claire M. Benner SCHEDULE. E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 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 NUMBER DESCRIPTION l. Checking Account 2. Savings Account 3. Trailer 4. Car 5. Car insurance refund 6. Homeowners insurance refund TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) FILE NUM ER 2105-4~2 VALU\: AT DATE OF EATH 6 , 5C 4 . 90 6,3'( 5.50 1,0~0.00 1,odo.oo :l8.00 8.00 14,986.40 II \ REV-1511 EX+ (12-9'3) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESiDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Claire M. Benner 2105-452 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION AMOJNT FUNERAL EXPENSES Richardson Funeral Home, Inc. 2,7 2.00 B ADMINISTRATIVE COSTS: 1. F'ersonal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees Jerry A. Philpott, Esquire 1,200.00 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. F'robate Fees 5. Accountant's Fees 6. 1ax Return Preparer's Fees 7. Advertising the Estate Patriot-News sentinel 219 18 101 64 TOTAL (Also enter on line 9, Recapitulation) $ 4 , 3 SE . 82 (If more space is needed. insert additional sheets of the same size) ~ REV-1513 EX+ (9-00) '* SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERIlANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Claire M. Benner . 105-45 RELATIONSHIP TO DECEDENT AMOUNT 0 SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ES TE I TAXAI3LE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Stephen A. Kohlhaas nephew 100~ , 2 ENTEq DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SH ET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)