HomeMy WebLinkAbout12-27-05
REV.1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Benner James R.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
04/25/2005 06/21/1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Benner Ann M.
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!XJ 1. Original Retum
o 4. Limited Estate
!XJ 6. Decedent Died Testate (Attach copy of Will)
o 9Kitigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12.12-82)
!XJ 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credn (date of death between 12-31-91 and 1.1-95)
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NAME
Jac ueline A. Kell
FIRM NAME (If Applicable)
Jan L. Brown & Associates
TELEPHONE NUMBER
717 -541-5550
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 04 8 9
"'CotiNTYCOOE -YEAR- - - NUMBeR- -
SOCIAL SECURIT'Y NUMBER
2 1 7 - 2 6 - 8 2 6 3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 01
COMPLETE MAILING ADDRESS
845 Sir Thomas Court
11,114.37 x L-- (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
Suite 12
Harrisbur
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7
ses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental 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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(8)
(11)
(12)
(13)
(14)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
PA 17109
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12,702.371
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OFFICIAL USE ONLY
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12,702.37
1 ,588.00
1,588.00
11,114.37
11,114.37
0.00
0.00
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ece en s omple e ress:
STREET ADDRESS'
47 LeAnn Court
CITY I STATE I ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
TotallnteresUPenalty ( 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)
5. If Line 1 + Line 3 is greater 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 Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
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; ........................................................................... 0 IXI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IXI
c. retain a reversionary interest; or ...................................................................................................... 0 IXI
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IXI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 IXI
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 IXI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 IXI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE 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 complete.
Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
SIGNATURE PERSON RESPONSIBL R FILING RETURN DATE
-5-05
ADDRESS
PA 17025
DATE
Q- /5--05
PA 17109
For dates of death on or after 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 spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
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% [72 P.S. ~9116 (a) (1.1) (ii)l.
The statute does not exemot 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 twenty-one 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% [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%, except as noted in 72 P.S. ~9116(1.2) [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% [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-1503 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Benner. James R.
FILE NUMBER
21 05
All property joinUy-owned with right of survivorship must be disclosed on Schedule F.
0489
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
6,240.20
2.
T. Rowe Price Services, Inc.
Science & Technology Fund Account #540121916-5
356.787 shares @ $17.49 as of date of death
T. Rowe Price Services, Inc.
International Discovery Fund Account #540135397-9
193.536 shares @ $33.39 as of date of death
6,462.17
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
12702.37
REV-1511 EX + (12-99)
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Benner. James R.
21
05
0489
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal 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 Jan L. Brown & Associates 1,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills, Cumberland County 58.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Register of Wills, Cumberland County--Inventory and Inheritance tax filing fees 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 1,588.00
Debts of decedent must be reported on Schedule I.
(If more space is needed. insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Rpnnpr ~mpc::R. ~1 Ofi 04RQ
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 pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Ann M. Benner spouse 100%
47 LeAnn Court
Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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, insert additional sheets of the same size)
Register of Wills of Cumberland County
INVENTORY
Estate of James R. Benner
also known as
James R. Benner
, Deceased
No. 2005 0489
Date of Death 4/25/2005
Social Security No. 217-26-8263
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jacqueline A. Kelly
I.D. No.: 91973
Ann M. Benner
Dated I .~ - I L~- 'J,Ot) 5
PA 17109
Description
Value
T. Rowe Price Services, Inc.
Science & Technology Fund Account #540121916-5
356.787 shares @ $17.49
T. Rowe Price Services, Inc.
International Discovery Fund Account #540135397-9
193.536 shares @ $33.39
6,240.20
6,462.17
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Total
(Attach Additional Sheets if necessary)
12,702.37
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
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