HomeMy WebLinkAbout07-11-06
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
~\
O~~ICIAL u!';!; ONLY Ct..
. . c-/
1[>\ '1,
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
Date of Birth
202200461
05112 006
1 0 1 9 1 9 2 7
Decedent's Last Name
Suffix
Decedent's First Name
BENDER
LEN A
MI
M
(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
[ZJ 1. Original Return
o 4. Limited Estate
o
o
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
J A N L B ROW N
71754 1 555 0
.:>
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
J A N L B ROW N ASS 0 C
First line of address
845 SIR THO MAS C T S TEl 2
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
H A R R I S BUR G
P A
17109
Correspondent's e-mail address:BRENDAJLB@VERIZON.NET
Under pe ties 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, 0 reet and complete. eclara 'on of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT E OF PERS ESP IBUiFOR FILING RETURN DATE
7/10/2006
PA 17050
MECHANICSBURG
ADD
845 SIR THOMAS CT STE 12 HARRISBURG
PLEASE USE ORIGINAL FORM ONLY
DATE
7/10/2006
PA 17109
Side 1
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15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name LENA M. BENDER
RECAPITULATION
202200461
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 & Notes Receivable (Schedule D) ....................... . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 7 6 9 7 8 3
...... .
6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 3 5 3 4 6 9 5
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested. . . . . . . 7.
8. Total Gross Assets (total Lines 1-7) .......................... . 8. 4 3 0 4 4 7 8
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 5 4 5 0 0
. . . . . . . . . . . . . . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............10. 2 9 8 6
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 5 7 4 8 6
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4 1 4 6 9 9 2
13. Charitable and Governmental Bequests/See 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. 4 1 4 6 9 9 2
TAX COMPUTATION - 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 .O~ 4 1 4 6 9 9 2 16. 1 8 6 6 1 5
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 17. 0 0 0
18. Amount of Line 14 taxable 0 0 0
at collateral rate X .15 18. 0 0 0
19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 8 6 6 1 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
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15056042126
15056042126
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
LENA M. BENDER
STREET ADDRESS
5287 E Trindle Rd
File Number
Hampden Township
CITY
Mechanicsburg
STATE
PA
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,866.15
93.31
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
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.
Total Credits (A + B + C)
(2)
93.31
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
(5)
(5A)
(5B)
0.00
0.00
1,772.84
4.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
1,772.84
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; ...................................................................... 0 lKl
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 lKl
c. retain a reversionary interest; or ................................................................................................ 0 lKl
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 lKl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 lKl
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 lKl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 lKl
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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [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 zero (0) percent
[72 P.S. ~9116 (a) (1.1) (U)l. 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 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 zero (0) percent [72 P.S. S9116(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 four and one-half (4.5) percent, except as noted in
72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P,S. s9116(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 + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHFRITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
LENA M. BENDER
FILE NUMBER
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
1.
DESCRIPTION
Citizens Bank; Account 620647-205-5
VALUE AT DATE
OF DEATH
5,641.08
2
Country Meadows Associates; resident refund (Lena Bender)
Check payable to Susan Gribble
2,056.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7697.83
REV-1509 EX + (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHI"RITANCI" TAX RI"TURN
RESIDENT DECEDENT
ESTATE OF
LENA M. BENDER
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Susan K Gribble
5287 E Trindle Rd
Mechanicsburg PA 17050
daughter
B
c
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL EST ATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 3/15/04 Prudential Financial Mutual Funds; Account 02808377190 33,211.44 50. 16,605.72
Dryden High Yield Fd CI A (PBHAX); 5826.568 shs @ $5.70/sh
2 A 2004 Citizens Bank; Checking Account 610070-124-7 1,380.07 50. 690.04
3 A 2004 Citizens Bank; Money Market Account 620326-702-7 15,514.02 50. 7,757.01
4 A 2004 Citizens Bank; CD 6247-351505 20,588.36 50. 10,294.18
TOTAL (Also enter on line 6, Recapitulation) $ 35 346.95
"
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INI-lI"RITANCI" TAX RI"TURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
LENA M. BENDER
FILE NUMBER
Debts of decedent must be reported on Schedule I.
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 claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Prepare(s Fees
7. Register of Wills, Cumberland County, filing fee Inheritance Tax Return 15.00
8 Register of Wills, Cumberland County, filing fee Petition Small Estate 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 1 545.00
(If more space is needed, insert additional sheets of the same size)
ATTACHMENT TO SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Bender, Lena M
FILE NUMBER
Legal fees reflected on Schedule H were incurred in connection with the decedent.
The attorney's fees are reasonable in amount considering the legal time required and
expense involved in these matters.
REV-1512 EX + (12-03)
'*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERIlANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENA M. BENDER
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Mobile X-Ray Imaging
29.86
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
29.86
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENA M BENDER
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Susan K Gribble, daughter Lineal
5287 E Trindle Rd, Mechanicsburg, PA 17055 Sch E and Sch F
2 Charles L Bender Jr, son Lineal
1414 Zimmerman Rd, Carlisle, PA 17013 Sch E
3 Patricia A Fickett, daughter Lineal
1416 Kuhn Dr, Boiling Springs, PA 17007 Sch E
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 I1- 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)