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Home My WebLink About07-05-07 ... . -.J 15056051058 REY-1500 EX(~) PA DepaItment of Revenue *' Bureau of Indvtdual Taxes PO BOX 280601 Hanisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW SocIal Number Date of Death OFFICIAI. USE ONLY ~-~..,.~--- 21 ! I 05 File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 0885 Date of Birth 207-58-2926 07/28/2005 07/24/1962 Decedenfs Last Name Suffix Oecedenfs First Name MI E WALLACE KENNETH (If ApplIcable) Enter Surviving Spouse's Infonnatlon Below ~:~~~lSt_t<l_~~___._._______________._._______.___ Suffix ~pouse's Fi~~ame _. MI .~P?~l!:!l_~ItI_~~.~.~lI~ber____._ THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <11:I 1. 0rtgInaI Return c:::) 2. SUpplemental Return c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. UmIted Estate c::> 48. Future Interest Compromise (date of c::> death after 12-12-82) c:::> 7. Decedent MaIntained 8 UYlng Trust (Attach Copy of Trust) c::> 10. Spousal Poverty Credit(date of death c::> 11. EIectlon 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 CONF1IlENTW. TAX INFORMATION SHOULD BE DIRECTED TO: Name _______._.._..___.______________.___ ...__~___ ______________________._._____ !?l:l~~~~~ ~1I~~_.______....____ c:::> 6. Decedent Died Testate (Attach Copy of WHI) c:::) 9. Utlgatlon Proceeds Received o 8. Total Number of Safe Deposit Boxes Robert R. Black ~i!'!'~!'!1!J~~p1~~!~) _. ! Landis & Black ! (717) 243-3727 ---------..--.--. ....--- ...-.---------. ..-, r----REGISTE~F-W1LLS US~L ";---1_.', ! Co ....a :tr) r; I i <.: :0 c- fLr:.: ~;:::;; i :::8 -0 c= jf:' 'oj I Cj ::r: (') r- r."; ,:0 'I -;] )> h=i I *f~; ~ >:;:;::;:0 U1 :Loo ..~_.--..- ---....---.-~~..----"---~----...-..-,.,-...-.---------...~~-....~----- _..: , ' '~U") ^ 1._..,:..... C.) (')0 -0 l"~ -n '~JO'" :J: k< -n '..'c t:'~...n ZIP Code !--------~~~P-.-..:;;:-.-i7; rn .-..-.................-......:J:>. .- i 17013 N First line of address 36 South Hanover Street Sealnd line of address or Post Office Carlisle ADO 58 36 South Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -.J REV-15Oll EX Page 3 .. Decedent's Complete Address: l..-_.__ ------- rs NAME DECEDENrS SOCIAL SECURITY NUMBER KENNETH E WALLACE 207-58-2926 STREET ADDRESS 2328 Ritner Highway CITY 1 STATE I ZIP 17013 Carlisle PA C'__ r-----l ,E!IIJmmt!l!L.__...___., ~~10885 I Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 673.26 Total Credits ( A + B + C ) (2) 0.00 3. InterestIPenalty if applicable D. Interest E. Penalty Open - See Letter TotallnterestlPenalty ( 0 + E ) (3) 4. If Une 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In oval on PIge 2, Line 20 to request I Nfund. (4) 5. If Line 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (5) (5A) (58) 673.26 A. Enter the interest on the tax due. 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 01' income of the property lransfened;.......................................................................................... 0 Is:a b. retain the right 10 designate who shall use the property transferred or its income; ............................................ 0 Is:a c. retain a reversionary interest; 01'.......................................................................................................................... 0 ~ 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? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" 01' payable upon death bank account or security at his 01' her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 Is:a 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) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and tiling a tax retum are stili 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. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent, 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 twelve (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. . .. --.J 15056052059 REV-1500 EX Decedent'a Name: RECAPITULATION KENNETH E WALLACE 1. Real estate (Sct1eduIe A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . .. .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorshlp (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . .. . .. . . . . . . . . . . . ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::> Separate Billing Requested.. . . . . .. 7. 8. Total GroM Aaeta (total Lines 1-7). . .. .. . . .. . . .. .. . .. .. . .. . .. . .. . .. ... 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10).. ... .. .. . .... . .. ... ..... ... . .. .. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ......... .. ........ .... .... . .. 12. 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. . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of line 14 taxable at lineal rate x.045 14,961.40 16. ""-'~--'"._'~'~~,-~,"-,",~---~,~,".~.......,,,,-....,-~~-,...~--.,.,. 17. Amount of line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. ~t:fent'l>~aISEl~rity tII~mber i 207-58-2926 149,000.00 0.00 0.00 58,433.09 207,433.09 35,037.01 157,434.68 192,471.69 14,961.40 0.00 14,961.40 19. TAX DUE......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 673.26 673.26 c:.\ 15056052059 --.J . R~V-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF WALLACE, KENNETH E. FILE NUMBER 21-05-0885 AU real property owned IDlely or II a tenant In common IllUlt be reported at fair market value. Fair marlalt value is defined as the price at which property would be exchanged betwaen a wiling buyer and a willing seier. neither being compelled to buy or seD. both having reasonable knowledge of the relevant fads. Rell property which II jotntly-owned wlth right of lurvlvorahlp mUlt be dllcloaed on Schedule F. ITEM NUMBER 1. DESCRIPTION All that certain tract of land with a ranch home erected thereon situate in Dickinson Township, VALUE AT DATE OF DEATH Cumberland County, Pennsylvania, as contained in Deed Book 249. Page 2769. Property 1.0. 09-0525-004. Assessment $134,380.00. Gross sales price as per attached HUD-1. 149,000.00 TOTAL (Also enter on line 1. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 149,000.00 . R~V-1508 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF WALLACE, KENNETH E. Indude the proceeds of HUgatlon and the date the proceeds were received by the estate. All properly JoIntly-owned with right of lurvlvol1lhlp mUlt be dllclosed on Schedule F. FILE NUMBER 21-05-0885 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Pro-ration of real estate taxes. See HUD-1 at Schedule A. 793.92 2. Sovereign Bank - Close Checking Account No. 1691017914. See attached letter. 3. Fidelity Investments - Ahold USA, Inc. - 401K Savings Plan Payout See attached letter. 2,518.83 9,051.15 132.89 4. Universal Underwriters - Refund Truck Insurance 5. Allstate Ins. Co. - Homeowners Refund 6. Adams Electric Co-Op - Rebate 7. Farmers Mutual- Insurance Refund 8. Sovereign Bank - Payoff Refund 9. Citi Mortgage - Escrow Balance Refund 10. Trustmark Ins. Co. - Rebate 11. U.S. Treasury - 2005 Income Tax Refund 347.00 17.79 126.50 516.97 7.51 27.90 908.63 12. IBIS Appraisal Service - Appraisal of personal property and autos. See attached appraisal. 13. Proceeds of Survival Action as per allocation set forth in attached letter from Dept. of Revenue dated 12.984.00 January 29. 2007 31,000.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 58,433.09 R'lV-1511 EX+ (12-99>_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDUU H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WALLACE, KENNETH E. FILE NUMBER 21-05-0885 DebI8 of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAl EXPENSES: 1. DESCRIPTION AMOUNT B. 1. ADMINISTRATNE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Barbara J. Myers I Paul E. Stone Social Security Number(s)/EIN Number of Personal Representative(s) 198-44-9016 160-60-8954 StreetAddress 703 Bloserville Road 9,233.91 City Newville Year(s) Commission Paid: 2007 . State PA Zip 17241 2. Attorney Fees 500.00 3. Family Exemption: (If decedenrs address is not the same as daimant's, attach explanation) Claimant None Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accounlanrs Fees 6. Tax Retum Preparer's Fees 7. PP&L - Invoice 8. Fanners Mutual- Homeowner's Insurance 9. IBIS Appraisal Service - Appraisal 10. Carlisle Petroleum - Fuel Oil 11. Omnium Worldwide - Sprint Account 12. RMS - Waste Management Account 390.77 213.91 208.50 300.00 368.85 185.85 55.56 TOTAL (Also enter on line 9, Recapitulation) $ 11,457.35 (If more space Is needed, insert additional sheets of the same size) \ l;arrTea fl'orward) .. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Continued - Page 2 ESTATE OF WALLACE, KENNETH E. FILE NUMBER: 21-05-0885 ITEM NUMBER DESCRIPTION AMOUNT (Brought Forward) 11,457.35 13. PPL - Final Bill 80.58 14. Eastern Account System - Comcast Account 125.34 15. Settlement Costs - Sale of real estate - See Attached HUD 11,528.40 16. Costs from estate to complete sale of real estate - See attached HUD 1,075.99 17. Attorney's fees allocated to Survival Action - $31,000.00 x 30%. See attached statement of settlement 9,300.00 18. Costs of suit allocated to Survival Action - 3,231.15 x 30% 969.35 19. Costs of closing and filing releases 500.00 TOTAL 35,037.01 REf1512 EX+ (12.03) '* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDUU I DEBTS OF DECEDENT, MORTGAGE UABIUnES, & UENS ESTATE OF FILE NUMBER WALLACE, KENNETH E. 21-05-0885 Report debIs IIICUITlIcI by the dececIent prior to deIth which I'IIMined ullPlid II of the elite of deIth, lncIucIing ull'llmbuned medIcII e~. ~M ~~M~~ NUMBER DESCRIPTION OF DEATH 1. Citi Mortgage, Inc. - Home mortgage payoff. See HUD-1. 119,143.88 2. em Mortgage, Inc. - Home second mortgage payoff. See HUD-1. 20,197.63 3. Capital One - Credit Card Account 600.00 4. NCD Financial Systems - Chase-Prov. Credit Card Account 3,679.22 5. Principal Bank - Credit Card Account 9,969.20 6. G.E. Money Bank - Lowe's Credit Card 2,057.13 7. Citibank - Home Depot Credit Card 781.31 8. Allstate Ins. Co. - Account 90.25 9. Citibank - Sears Robuck & Co. Account 916.06 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 157,434.68 ~ RE~.1513 EX+ (9-00) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF WALLACE, KENNETH E. FILE NUMBER 21-05-0885 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List TrustN(.) OF ESTATE I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Ralph W. Wallace Father 50% P.O. Box 397, Shermansdale, PA 17090 S.S.No. 162-22-6408 2. Betty S. Wallace Mother 50% P.O. Box 397, Shermansdale, PA 17090 S.S. No. 206-32-2757 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET U 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" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) ~_.,...;';. o-.NO.-- db A. 8. 1\'PE OFlCWt 10FHA 2.[]FPlHA 3.(]coNv. LNNS. 4-[]vA &.(JcoN.1NS. u.s. DEPAR'IIEIII'OFHDUIII8" URIWI ~ .. FIlE NUMlIER: 17_ lQANNMER: sETTLEIIENT SfATEIlIEIrI' WAStER .. IIOR'IlWJE INS CASE NUMlIER: C. NOTE: 1'* bnI. tImIIIted ID"". JllIIa ........,tI...,..-.rCllllll. ~""ID_IIr" --..--....... ....-*-I7'OCT-".,aaIIfdt..........-......-... L IT ~,.....__not......II....... u_ D. HAlE AND ADDRESS OF IlORR(MER. E. IWEAND ADIlREII8 OFllElLER: F. !WE NllDADDIlEBS OF l.ENDER: ..., A. WIiIIW ....... "'....... E. ..... 33OWIiIIW.... .........., ....... PA 17241 c.tIIIIt, PA 17013 G. ~ln0CA11ON: H. SET1l.I!MENT AGENT: 25-1Ol818 lSEnLBlENfDoJ.1E: 2S28 ........... ....., L GlIIlt, ...... ~30.2OlI5 C8IIIle. PA 17013 ~c.nr. F'.a.aJ)t.... PlACE OF 8E111.EIENT 2lllI NDIlh"--ShIII c.IIIt. PA 17013 .. J. _~ =OF~ 101. c-..g- ;-=- 1A s.lIIIMnl~lItean- ... 104. 404. 105. 405. ....,.,811.....11..... AIr....,.,.......II- 10ll 8dIDaIT_ 1281ll1ll lit _ 7IIZ.lIZ 40ll SdIlIIIIT_ 12I38IIlI ID __ llII2.32 107. 1- ID 12fSU15 ''- <<r1. 12I3lIII5 III 12mDi 1.- 108. 1ft 40ll III 101. a.~T_ 11G. ......T_ 111. 411. 112. 412. 120. GROSS MIOUII'fDUEFROIf8OflROlllBt ~~ 148.793.lIZ OF~~ ~ 2lrL at fI02. lit 1- 11.l12i1.40 2lD. lit IiID. III ... .....1If1lll III Inc. 118143.88 2lJlS. """" _'1117_ 2lI8. lIOll 1l11. SlJ7.-~"'_- 2lI8. sa 2lI8. IllIl. AIr.... ..-....... ~AIr....~8II..... 21G. .....,-.- lit 51D. lit 1. ID 811. ID lit 812. .. . lit 213- 513. 214. 814. 21&. 51&. 211. 81lS. 217. .. err. 218. 518. 218- 818- ZlIl1 l'OTAI.PAI) BYFOR 80IRCllWiR 5,lIOIUID .. 7OTAl. REDUC'fIONMlD4MTDUE SELLER 1l1ll,8a8t .... -- CAllI" I~ 1301. QIag~DueFnllllean-== ~!!U-' o.1bMw ,.1IlUII2 .-- L-.~"""_~ IIl2. L-.~o..... 111U1l18.fl 303. CASH ( X FROM) ( ro) 8OflROlIIBt 147,,434.42 lID. CASH ( ro) ( X RfOII) SSJ.ER 1,l115.l18 ..............___...__.._.......-...- l '_..-:,.~ - ~ (J. h!a~ -r&i1[) flI0. -, ~ ~!J;llrfJ-<-[J cJ.0_JPltJlI ~-j;;- 1fl~ Iz/3tj(}~ <Jf;1;-tStJ$ J I (71 f{ 1U).1__~ . ~I{~~- L SEnl.EMENTCHARGES -..... -..... S 148J11JDJ1O .. lUIIIIIO ~ ._m - .uInl _AT _AT IE . .)> ~ ~ It,8W.UlI III . ...IIIMIPAY. ll!.car.II~_WllHLCWIIlI IliiH. .... .. III 11II2. L-. DIIaouat .. III ID III III III Ii> .....-~-BY.....lO_PMJ.IIINN<<:E Iiiii I %) llO1. .......... III ill S .. 103.~~1iIr III 1.0 - III 11IM. 8lI6. ta.r .- WIIH..... 1& ..... ..... 1l102. ___ IIIlIIIIM -- ..... T-. ..... JIllIIlIh 1 . IIIlIIIIM ... 1001I. · r ........ ..... S ..... 1_- - S -- 101r1. .... S ..... f1iiiiL -.0- . -- 11"1I1U!~ 1101. ar~"" III 1102. Ablbctar-r.SiImb III ~M.I.cl"" 117J111 1103. III 1104.11IIt"-'-___ III 11" .... IlI-L 2OJIO 11_ ~-... III c.lt s.i'ii 1O.lIO, ill III J ID .r.aw... --...: J S S III 7_ 1 11113- 1--GDVI!IU_ITAECONINJ_.........~ _o.d S ,3I.5O:~S == ~$ 3UDI 1.-- 1203.... .........___ I 1A8lU1ll 121M. I 1205- I 1"'~~CHARIB 1301. ~ III . 131l2. ..... III ............. ClalInII 13llL -.... III DEW.. s.. 3lIO.00 131M. -T_ 1lIB1S 13DIL T.... TMlIlaiiiii III ............Inc. lS7ll.40 ita 1OTAL~~ fEnIIIr......1G............ 2.&IIL!IIII 1Ui2llAII ...---1....-...___....................._.._11..... '"" '-'- V ~ III .......capy ~ .....11 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Kenneth E Wallace .207-58-2926 July 28, 2005 Account #: 1691017914 Type: Checking In the name of: Kenneth E Wallace or Kathryn E Wallace Date of Death Balance: $2,518.83 Int.(YTD) from 1/1/2005 to 2/13/2005 Accrued interest to date of death: $0.00 Other Info: Open date: 12/16/1987 $0.39 Account #: n-6817586348 Type: In the name of: Kenneth E Wallace Balance Due at Death: Installment Loan Open date: 12/30/2004 $4,071.24 Page 1 of 1 --. ."~i!lf1fl" ADOLD USA, INe. 401I SAVINGS PLAN FOR HOURLY ASSOCIA'J'm TOTAL DISTRlBurION STATEMENT 35nS MG4K THE ESTATE KENNETH E. MALL BARBARA J MYERS a PAUL E. STONE A"'INISTRATORS 36 SOUTH HANOVER STREET CARLISLEr PA 17013-0000 BNCLOSBD IS THB CHBCK FOR THE DISTRIBUTION YOU RBQUBSTBD. PLEASE VBlUFY THAT AlL THE INFORMATION IS CORRECl' BEFORE CASHING YOUR CHBCK. BMPLOYBB NO.: 207-5&-2926 DIVISION NO. : 400 TYPE : TOTAL DISTRIBUTION - NO D1lU!CT TRANSFER EMPLOYMENT DATE : 06/22/1999 PARTICIPATION DATE : 0I/1Sf2000 TBRMINATlON DATE : 07/29/200S TRANSAcrION DATB : 07PAf1OO6 FUND INFORMATION Pm PRBBDOM 2020 .EIUQi $14.5200 SHARl3S WITHDRAWN CASH WITHDRAWN 623.357 S9.oSl.15 THBSB ARB THB FUNDS APPIlCl'BD BY YOUR wrrHDRAWAL SOURCE INFORMATION V AMO B G PER.CSNT WITHDRAWN ASSOCIATE VOWNTARY $4.03125 100.00 S4,.032.2S COMPANY CONTRIBUTIONS SS.oI&.90 100.00 15.018.90 THBSB ARB THE SOURces AFFBCTBD BY YOUR WITHDRAWAL DJSTIUBUTlON SUMMARY TAX INFORMATION BEGINNING BALANCB LBSS WITHDRAWALS ENDING BALANCE 19.051.15 ( S9.os1.1S) S.oo TOTAL DISTRIBUTION TOTAL TAXABLE AMOUNT ORDINARY INCOMB AMOUNT BUGIBLB FOR ROLLOVeR. S9.os1.15 S9.os1.1S $9.os1.15 $9.os1.15 CHKCJ( INFORMAnON THB BSTATB ICBNNBrH B.. WAUACB BARBARA J MYBRS & PAUL B.. STON ADMlNIST'RATOItS 36 SOtn'H HANOVBR. STRBBT CARLISLE. PA 11013-0000 CIiBCK DATE 07PA/2006 CIIBCX NUMBeR. 228004663 GROSS AMOUNT FBDBRAL TAX NBr AMOUNT S9.os1.15 SI,,10.23 $7,140.92 PLBASB VBRlFY THAT THIS INFORMATION IS CORlU!CT PLBASB VBRlFY YOUR TRANSAcnON FOR ACCURACY AND REPORT ANY DISCRBPANCIES TO PlDBln"Y INVBSTMBNTS AT 1-800-249-401S. . APPRAISAL SUMMARY It is in my opinion, that as of d.o.d. July 25,2005, the Fair Market Value of the personal property of Kenneth Wallace, deceased: (Twelve Thousand Nine Hundred Eighty Four Dollars and Zero Cents) ($12,984.00) IBIS APPRAISAL SER VICES The report must be read in its entiretv. The Appraisal Summarv ONLY is not the aqoraisal report 4 OFFICE OF CHIEF COUNSEL ~O. BOX 1061 . \ HARRISSUr{G. PA 17128-1061 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE January 29, 2007 David S. Wisneski, Esq. Navitsky, Olson, & Wisneski LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 Thomas J. GohsIer Direct Dial: (717) 783-7539 tgohs/er@s1ate.pa.U$ Fax: (717) m-1459 Re: Estate of Kenneth Wallace, Deceased Inheritance. Tax Wrongful Death/Survival Allocation Request File Number 2105-0885 Dear Mr. Wisneski: The Department of Revenue received your letter dated December 21, 2005, concerning a petition to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It was forwarded to this Office for the Department's approval of the allocation of settlement proceeds. , Pursuant to your, ,letter., the forty-three. year old decedent died on July 28, 2005 as a result of injuries sustained in an automobile accident. Decedent died intestate and is survived by a sister and a nephew. The Police Report attached to your letter indicates that the decedent was trapped. within a burning vehicle and died as a result of burns sustained. Please be advised that. based upon these facts and for inheritance tax purposes only, this Departme~t has no objection .to the proposed. allocation of the gross proceeds of this action, $124,000.00 to the wrongful death claim and.$31,000.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A; S 8302; 72 P.S. SS 9106; 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). -- David S. Wisneski, Esq. January 29, 2007 Page Two I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, I will not be attending any hearing regarding it. Please do not hesitate to contact me if you or the Court has any questions or requires anything additional from this Office. TJG:sp H:\OCC DOCS\WALlACEESTATE(NO. 19837).OOC . .. ~ NA VITSKY, OLSON & WISNESKI LLP ATTORNEYS AT LAW Paul E. Stone and Barbara J. Myen, as Co-Administraton of the Estate of Kenneth E. Wallace v. Estate of Jovce G. Case TOTAL AMOUNT OF SETTLEMENT $155,000.00 Attorneys' Fee (Pursuant to Court Order - 300A.) Subtotal -$ 46.500.00 $108,500.00 -$ 3.231.15 $105,168.85 Less NOW LLP Expenses Total net distribution to Beneficiaries Wrongful Death aUocation (80% of net settlement proeeeds) 584,215.08 Snmval Action allocation (20% of net settlemeDt proceeds) $11,053.77 ~ ~ AND NOW, this~dayof ~. 2007, we acknowledge that we have read, understood, approved and obtained a 0 y of this Distribution Sheet. We further acknowledge that the above balance constitutes the total reimbursement for medical expenses, wage loss pain and suffering and other losses sustained or claims resulting from the death of Kenneth E. Wallace. We warrant that if there are any outstanding medical bills or claims other than as set forth above, they will be our responsibility. We further warrant that we will pay any outstanding medical subrogation liens or expenses not noted above. ~~~ Paul E. Stone {]~~.M;r .~ 20i0 Linglestown Road. Suite sos . Harrisburg, P A 17110 Phone: (717) 541-9205 Fax: (717) 541-9206 Toll Free: 1-800-818-9608 www.nowllp.com . ' . Telephone (717) 787-8014 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 July 10, 2006 David S. Wisneski 2040 Linglestown Rd. Suite 303 Harrisburg, Pa. 17110 Re: Estate of Kenneth Wallace File Number 2105-0885 Dear Mr. Wisneski: The Department has been advised that the above-referenced estate is presently involved in litigation. The Department will suspend further activity on this estate until July 10, 2007. You are required to notify the Department when the status changes or the extension date expires. If you have any questions, please contact me at (717) 787-8014. Sincerely, DhOI.',_ ~ Phyllis ~--> Inheritance Tax Division FAX 717-772-0412 Email-phoch@state.pa.us