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Home My WebLink About10-04-07 (2) 1t '.. '--.J 15056051058 REV-1500 EX (06-05) PA Deparbnent of Revenue . Bureau of Individual Taxes . .'illli. PO BOX 280601 .. Harrisburg, PA 17128-0601 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year ~ File Number 05 2005-837 Date of Birth 161-54-1983 07/22/2005 09/23/1964 Decedent's Last Name Suffix Decedent's First Name MI HOYER MILDRED (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 2. Supplemental Return 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 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 4. Limited Estate . 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Todd Berkey, Esquire (412) 394-f1401 :;:...::. fr'" -::::.-""--<' \ REGISTElt6F!WILLS UsEONLY Firm Name (If Applicable) Edgar Snyder & Assoc. First line of address 600 Grant Street Second line of address 10th Floor c~'~ I'. ,. City or Post Office State ZIP Code DATE FILED Pittsburgh PA 15219 Correspondent's e-mail address: 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 ?F PERSON R ---.-~ ADDRESS 600 Grant Street, 10th Floor, Pittsburgh, PA 15219 SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE DATECj I J~l /01 DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J .. -I 15056052059 REV-1500 EX Decedent's Name: MILDRED HOYER RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) 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. 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 1-7). . . . . ................ 8. 9. Funeral Expenses & Administrative Costs (Schedule H). 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) . . . . . . . . . . . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . 12. ......13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(l.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O 45 10,879.00 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 . . . . . 14. 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 161-54-1983 1. 0.00 2. 0.00 0.00 0.00 32,464.00 0.00 0.00 9. 32,464.00 18,585.00 3,000.00 21,585.00 10,879.00 0.00 10,879.00 489.55 489.55 15056052059 --.J REV-1500"EX Page 3 File Number Decedent's Complete Address: 2005-837 Dt'€EDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER MILDRED HOYER 161-54-1983 ~-- .-~.- STREET ADDRESS 120 Winston Drive ---..--.-- --_._-----~ ---.,--- .n._._. I STATE I ZIP CITY Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 489.55 Total Credits (A + B + C ) (2) 0.00 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. Fill in oval on Page 2, Line 20 to request a refund. (4) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 0.00 489.55 0.00 489.55 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. 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 00 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 00 c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 00 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. 99116 (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. 99116 (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 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. 99116(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 PS. 99116(1.2) [72 PS. 99116(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. 99116(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 INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISe. PERSONAL PROPERTY ESTATE OF MILDRED HOYER FILE NUMBER 2005-837 ITEM 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. DESCRIPTION Proceeds from wrongful death action: Kimberly Harper as Administratrix of the Estate of Mildred Hoyer V. Jena Leffler, Court of Common Pleas of Northumberland County, PA. Case No. CV-06-800 VALUE AT DATE OF DEATH 32,464.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 32,464.00 REV-1511 EX+ (12-99) , '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MILDRED HOYER FILE NUMBER 2005 - 837 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 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 500.00 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. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 8 Attorney fees for litigation case (estate's prorated share) Costs - litigation (estate's prorated share) 16,666.00 869.00 550.00 7. 9 Attorney Torquato - misc. administration expenses TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 18,585.00 REV-;512 EX+ (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MILDRED HOYER FILE NUMBER 2005-837 ITEM NUMBER 1. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH DESCRIPTION Gitil::ank CrI3:lit-\'r Citibank (South Dakota), N.A., Sears Roebuck & Co., charge account ~CES (see attached invoice) 3,000.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,000.00 Ub/1~/~UU/ 1/:18 7538528455 BALOGH BECKER PAGE El2/D2 !'INNU:l1iA O"ICI: ME' A, -'-LOCH - loiN G~n w, Il~CK~~ - DC, FL, fl, MN, WI' .C~~;!llfOR'$ RIGI<TI; SPECIALIST AMERICAN BOARD 0' CERTIFIC;"~ON ANGELA M. HOllN - loiN NY .......RV ELm.J W~~",^N - KS, MN. 1010 STEVEN M. TOMS - MN MEACAI-I M. PROIl5T - MN MICH^~l J. OOUGflF.R'r'y - IN, MN IILL M. GEMLD - loiN ~~~\~L~E6~! ~ MN JACK All"lr III - ~, fl'-N I^$ON R. NTllVP - MN. NO n- A RH'IA - MN MARrnA J. BALDWIN _ MN BALOGH BECKER, LTD. ATTORNEYS AT ILAw M.CHIGJl.N OFFICE: 24300 KARIM BLVD. NoV!, MI 48375 0.1' COl.!N5~L; lIrow LAw OFfiCES, P.C. (lowAI LU5TIC, GWER & WILSON, ~.C. IMAS5ACHUSmsj SEND ALL WRITTEN REPLIES TO; 4150 OLSON MEMORIAL HIGHWAY. SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-fI440 FAX 866-234-0503 TOLL-FREE 888-762-9997 Hou~ (CST): 7:0001\'1 - 9:00 pm M - TH 7:00 <:11\'1- S:OO pm F 8:00 Qm - 12:00 pm S June 19, 2007 Re: Our Client: Account No: Unpaid Balance Due: Balogh Becker Reference No: Citibank (South Dakota), N.A. Sears Roebuck & Co ************8165 4192.83 2078297 Dear Sir or Madam: Thank you for your response in resolving this matter, P()r your request, this letter confirms a settlement in the amount of$3000.00 for the above .listed account. Receipt of this payment will close the account. It is our understanding that you will send this payment to our office by 09/17/07. Please pay the amount to the above address. If you have any questions, pIllase feel free to contact our office tol1 free at 1-877-768-4494. If you accept this offer, you may receive an Intemal Revenue Service form l099-C. Cordially, Balogh Becker, Ltd. Attorneys at Law This firm is a debt collector. We are attempting to collect a debt and any information obtained will be used for that purpose. "'Dolnc~ '_o'Vcr Portion And RC~lrn with raym~nt*" CONBALOOJ7.124 !2078297-7322-6.l9.~007! LAW FIRM OF BALOGH BECKER, LTD 4150 Olson MemorIal Highway, Suitt? 200 Minneapolis, MN 55422"4811 ADDRESS SE;RVICr: REQUESTED Account #: 2078297 Balance: $4192.(\3 Amount Enclosed: [$ .Il.me 19, :2007 Bf\LOGH SEeKER, LTD 4150 Olson Memoriall-lighwoy Suite 200 Mlnnecpoli$ MN 55422-4811 1.1,11 1111,1 11,1111. ! "I, 1,1111/.,111 " II " I 111.1 " I, 11,11. 1,1 Personal Reprt?sentotive for the Estate of: MILDRED HOYER C/O TODD BERKEY US Steel Tow~r 10th FL 600 GRANT STREET PllTSBURGH. PA 15219 IN THE COURT OF COMMON PLEAS OF NORTHUMBEl'-LAND COUNTY, PENNSYLVANIA KIMBERL Y L. HARPER, as Administratrix of ) CIVIL DIVISION the Estate of MILDRED L. HOYER, Deceased, ) ) No.: CV-06-800 Plaintiff, ) ) vs. ) ) JENA LEFFLER, ) ) Defendant. ) AND NOW, to-wit, this ORDER OF COURT ;r day of 4~ 2007, upon consideration of the foregoing Petition for Approval of Settlement of Wrongful Death and Survival Claims on Behalf of the Estate of MILDRED L. HOYER, Deceased, it is hereby ORDERED and DECREED that the Wrongful Death and Survival Claims of the Estate of MILDRED L. HOYER, Deceased, arising out of the July 22, 2005 motor vehicle collision, may be settled as follows: 1. Gross settlement in the amount of Five Hundred Thousand Dollars ($500,000.00) to be distributed as follows: a. The amount of One Hundred Sixty-Six Thousand, Six Hundred Sixty-Six Dollars ($166,666.00) payable to Edgar Snyder & Associates, LLC, for attorneys fees in the amount of Thirty-Three and One-Third Percent (33 1/3%); , b. The amount of Eight Thousand Six Hundred Ninety-Three Dollars ($8693.00) payable to Edgar Snyder & Associates, LLC, for reimbursable costs in this matter; c. Two Hundred Ninety Two Thousand, One Hundred Seventy-Six Dollars and Ninety Cents ($292,176.90), which represents Ninety Percent (90%) of the remaining settlement, to the wrongful death action, to be further distributed as follows: #867160 '_"I,~.~_1t #867160 1. Two Hundred Ninety Two Thousand, One Hundred Seventy-Six Dollars and Ninety Cents ($292,176.90) to Tori Coleen Hoyer, surviving daughter of Mildred L. Hoyer, Deceased, to be placed into a structured settlement as described below; d. Thirty Two Thousand, Four Hundred Sixty-Four Dollars and Ten Cents ($32,464.10), which represents Ten Percent (10%) of the remaining settlement, to the survival action, to be further distributed as follows: 1. Three Thousand Dollars ($3000.00) payable to Balogh Becker, Ltd., as full and final settlement of the claim made by Citibank against the Estate of Mildred L. Hoyer, Deceased; 11. Four Hundred Eighty-Nine Dollars ($489.00) payable to the Cumberland County Register of Wills for estate taxes; and, 111. Twenty-Eight Thousand, Nine Hundred Seventy-Five Dollars and Ten Cents ($28,975.10) to Tori Coleen Hoyer, surviving daughter of Mildred L. Hoyer, Deceased, to be placed into a structured settlement as described below. e. Tori Coleen Hoyer, surviving minor daughter of Decedent, will receive a total of Three Hundred Twenty-One Thousand, One Hundred Fifty-Two Dollars ($321,152.00) as a result of the settlement of this matter, to be placed in a structured settlement annuity offered through John Hancock Life Insurance Company, with a present value of Three Hundred Twenty- One Thousand, One Hundred Fifty-Two Dollars ($321,152.00), a guaranteed payout of One Million, Four Hundred Sixty-One Thousand, Two Hundred Sixty-Eight Dollars ($1,461,268.00), and a total potential projected payout of Two Million, Five Hundred Twelve Thousand, One Hundred Thirty-Eight Dollars ($2,512,138.00), payable to Tori Coleen Hoyer as follows: 1. Beginning on January 1, 2019, when Tori reaches the age of twenty-five (25), One Thousand Two Hundred Forty-Three Dollars and Forty-Three Cents ($1243.43) for life, payable monthly guaranteed for forty (40) years, increasing at a rate of 2.00% compounded annually, with the last guaranteed payment on December 1,2058; 11. On January 1, 2012, when Tori reaches the age of eighteen (18), a guaranteed lump sum payment of Twenty Thousand Dollars ($20,000.00); 2 111. On January 1,2015, when Tori reaches the age of twenty-one (21), a guaranteed lump sum payment of Twenty Thousand Dollars ($20,000.00); IV. On January 1,2019, when Tori reaches the age of twenty-five (25), a guaranteed lump sum payment of Thirty Thousand Dollars ($30,000.00); v. On January 1, 2024, when Tori reaches the age of thirty (30), a guaranteed lump sum payment of Forty Thousand Dollars ($40,000.00); VI. On January 1, 2029, when Tori reaches the age of thirty-five (35), a guaranteed lump sum payment of Fifty Thousand Dollars ($50,000.00); VII. On January 1, 2034, when Tori reaches the age of forty (40), a guaranteed lump sum payment of Sixty Thousand Dollars ($60,000.00); VIII. On January 1 2039, when Tori reaches the age of forty-five (45), a guaranteed lump sum payment of Seventy Thousand Dollars ($70,000.00); IX. On January 1, 2044, when Tori reaches the age of fifty (50), a guaranteed lump sum payment of Eighty Thousand Dollars ($80,000.00); x. On January I, 2049, when Tori reaches the age of fifty-five (55), a guaranteed lump sum payment of Ninety Thousand Dollars ($90,000.00); and, Xl. On January I, 2054, when Tori reaches the age of sixty (60), a guaranteed lump sum payment of One Hundred Thousand Dollars ($100,000.00). f. The annuity contract in question provides for an Internal Rate of Return (IRR) of 5.78% for which the taxable equivalent yield is 8.03% and shall not be transferred or assigned to another company without prior approval of the Orphans' Court Division of this Honorable Court. 2. It is further ordered that Plaintiff-Petitioner, KIMBERLY L. HARPER, as Administratrix of the EST ATE OF MILDRED L. HOYER, Deceased, is authorized to execute any necessary documents on behalf of the ESTATE OF MILDRED L. HOYER, Deceased, to #867160 3 ,'i;......,~m....,...lI""... " , settle all claims relative to the injuries and damages arising out of the July 22, 2005 motor ~.. vehicle collision, 3. Proof of purchase of the annuity is to be filed with the Orphans' Court of Northumberland County within thirty (30) days of receipt of the executed and issued annuity documents by Todd Berkey, Esquire. BY THE COURT: ~4 J. Extracted from the records and certified this 2:3 day .~ ~5W3+ #~~~4bL ~~~ary My Commission Expires First Monday of January, 2008 :-...:t ~ '"U c:>> .# ..... ;0-, l> 0;- c::= -,~ G'") '-n . . ::r: : 0 U1 \"- Z :1 OC :> 'm ~c ::ill: 0 ;o~ '-9 -< U1 .;",."" +" ~:D., #867160 4 ;;...,.::':t?'( "', ~. t):L:,',,,'f.i[I