HomeMy WebLinkAbout03-03-08
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15056041147
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
OFFICIAL USE ONLY
County Code Year
File Number
..
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
0523
Date of Birth
59196 3 8 5 8
02 14 2007
03 15 1990
Decedent's Last Name
Suffix
Decedent's First Name
DAGAN
IAN
MI
P
(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 \",1 APPROPRIATE OVALS BELOW
; X 1 Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
4a. Future Interest Compromise
(date of death after 12-12-82)
6. Decedent Died Testate
(Attach Copy of Will)
7. fA~f:g~cto~:i~:~~~)a Living Trust
8. Total Number of Safe Deposit Boxes
',X: 9. Litigation Proceeds Received
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORR.ESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name! Daytime Telephone Number
JAMES D. HUGHES ESQ, 717 249 633~.)
Firm Name (If Applicable)
SALZMANN HUGHES PC
, .
REGISTER OFWf(tS US~9NL Y
First line of address
,-.-j
354 ALEXANDER SPRING ROAD.
Second line of address
c-,
DATE FILED
City or Post Office
CARLISLE
State
PA
ZIP Code
17015
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 t"ue, correct and complete. Declaration of preparer other than the personal representative IS based on all information of which preparer has any knowledge.
SI TURE OF PER N R ONSIBLE FOR FILING RETURN DA TE
PaulP.Dagan
oad, Carlisle, PA 17013
James D. Hughes Esq.
<""l-
00
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'--...-.-.---.....
ander Spring Road, Suite 1, Carlisle, PA 17015
Side 1
15056041147
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15056042148
REV-1500 EX
Decedent's Name Ian P. Dagan
REC)~PITULA TION
1. Real Estate (Schedule A)p
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D)......p...............................
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)...
6. Jointly Owned Property (Schedule F) ~j Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property
(Schedule G) Separate Billing Requested....p 7.
8. Total Gross Assets (total Lines 1-7).....
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)............................................................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J)p ............................p............. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13).......................................
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
14.
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~ 223 641 91 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 00 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 00 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 00 18.
19. Tax Due.............. ................ .................................... 19.
Decedent's Social Security Number
591 96 3858
1.
2.
4.
5
372,839,85
8.
372,839.85
149,197.94
9.
149
197
94
223 641 91
223 641.91
o 00
o 00
o 00
o 00
o 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. D
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Side 2
15056042148
15056042148
....J
ESTATE OF
Dagan, Ian P.
PA Inheritance Tax Return
Signature of Additional Fiduciaries
FILE NUMBER
21-07 -0523
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 #2
Name
Address1
Address2
City, State, Zip
Date
Verna J. Dagan
11 Beagle Club Road
Carlisle, PA 17013
d./~lI;)O ?
.
REV-1S00 EX Page 3
Decedent's Complete Address:
DECEDEr~T'S NAME
lain P. Dagan
STREET ADDRESS
11 Beagle Club Road
File Number 21-07 -0523
CITY
STATE
ZIP
Carlisle
PA
17013
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
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
0.00
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A Enter the interest on the tax due.
B. Enter the total of Line S + SA. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(SA)
(5B) 0.00
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;.... .............................. ..................
b. retain the right to designate who shall use the property transferred or its income;.... ...............
c. retain a reversionary interest; or..... .................................. ................... ..... . .. .............
d. receive the promise for life of either payments, benefits or care?..................................
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.............................. ............................... ................. .
3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.......... . .................. .....................................
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. S9116 (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. S9116 (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. 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.S) percent,
except as noted in 72 PS. S9116 12) [72 P.S. S9116 (a) (1)].
The tax ratl9 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)
,~
~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMCNWE.~L TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dagan, Ian P.
IFILE NUMBER
21-07 -0523
ESTATE OF
Include the proceeds of ;itigatlon and the date the proceeds were receIved by the estate
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBEH DESCRIPTION
1 Survival Action proceeds
VALUE AT DATE
OF DEATH
372,839.85
TOTAL (Also enter on Line 5, Recapitulation)
372.839.85
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMON1flEAL TH OF PENNSYL'/ANIA
INHERITA.NCE TAX RETURN
RESiOENT DECEDENT
Dagan, Ian P.
DElbts of decedent must be reported on Schedule I.
I FILE NUMBER
21-07 -0523
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees SALZMANN HUGHES PC 149,135.94
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 47.00
5 Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 149,197.94
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev 6-98)
Rev-1502 EX" (6.98)
,~..>
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SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
CCMMONWEAL TH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
Dagan, Ian P.
IFILE NUMBER
21-07 -0523
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills
15.00
Subtotal
15.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B? (Rev. 6-98)
REV-1513 EX+ (9-00)
SCHEDULE d
BENEFICIARIES
COMMONWEAL TH OF PENNSYLVANIA
iNHERiTANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Dagan, Ian P.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-07-0523
ESTATE OF
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
PaulP.Dagan
11 Beagle Club Road
Carlisle, PA 17013
Father of Minor
Decedent
Verna J. Dagan
11 Beagle Club Road
Carlisle, PA 17013
Mother of Minor
Decedent
Total
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
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
IN THE COURT OF COrt!yION PLEAS OF
CUMBERLAND COl:NTY, PENNSYL VA~L\
In Re: Estate of Ian Paul Dagan
ORPHANS' COURT DIVISION
NO. 21-07-0523
RE: Petition for Approval of Settlement of \Vrongful Death Action
Pursuant to Orphans Court Rule 3 and Section 3323 of the Pennsylvania
Probate, Estates and Fiduciaries Code, as amended.
ORDER APPROVING DISTRIBUTION OF SETTLEMENT PROCEEDS
AND NOW, this ~'
day of J amiary, 2008, IT IS HEREBY ORDERED that
the settlement and proposed distribution of the settlement proceeds set forth in the
attached Petition is approved, and the proceeds from such settlement shall be paid as
follows:
1. The sum of $214,277.97 shall be paid to Paul P. Dagan and Vema J.
Dagan, as Administrators of the ESTATE OF IAN P. DAGAN, Deceased, in the survival
action claim brought as a result of the death ofIan Paul Dagan.
2. The sum of $321,416.96 shall be paid to Paul P. Dagan and Vema J.
Dagan, in thcir individual capacities in the wrongful death claim brought by them f()!;
damages incurred by them, as individuals, as a result of the wrongful death of Ian Paul
Dagan.
3. Nationwide Insurance Company shall retain $100,000.00 and Eric-
Insurance shall retain $387,232.97 of the settlement funds until the lien issue with tH2
Department of the Navy is settled, arbitrated or resolved by a separate court proceeding.
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4. The sum of $270,895.25 shall be paid to Salzmarm Hughes, P.C. as
attomey fees.
5. The sum of $6,176.85 to Salzmann Hughes, P.C. as reimbursement for
expenses.
6. Should any of the remammg settlement funds in the amount of
$487,232.97 be paid to the Estate of Ian Paul Dagan and/or Paul P. Dagan and Vema J.
Dagan, these funds shall be allocated on the same percentage basis as used in Paragraphs
1 and 2. The attorney fees shall also be based on the same percentage as used in
Para!,rraph 3. Salzmarlli Hughes, P.C. shall also be entitled to reimbursement for any
additional expenses incurred in this matter. The Petitioners shall not be required to file a
new Petition for Approval of the Settlement Funds before dispersing the proceeds.
BY THE COURT:
J.
WEB ADDRESS www.state.pa.us
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO Box 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
December 13, 2007
E. Ralph Godfrey
Salzmann Hughes, PC
354 Alexander Spring Rd., Ste. 1
Carlisle, PA 17015
Re: Estate of Ian P. Dagan
File Number: 2107-0523
Date of Death: 2/14/07
Court Number: CCP Cumberland Co. No. 21-07-0523
Dear Mr. Godfrey:
The Department of Revenue received a petition concerning the approval of Settlement
Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and
survival action. It was forwarded to this Bureau for the Commonwealth's approval of the
allocation of the proceeds paid to settle the actions.
Pursuant to the petition, the 16-year-old-decedent died as a result of a motor vehicle
accident. The heirs to the decedent's estate are his parents. Therefore, any proceeds paid to
settle the survival action would pass to the decedent's parents and would be subject to a zero
percent inheritance tax rate. 72 P.S. s9116(a)(1.2). Accordingly, regardless of the allocation
of the subject proceeds, there would be no inheritance tax consequences.
Please be advised that based upon these facts and for inheritance tax purposes only,
this Department has no objection to the proposed allocation of the gross proceeds of this
action, 60% to the wrongful death claim and 40% to the survival claim. Proceeds of a survival
action are an asset included in the decedent's estate and, although subject to the imposition of
a zero percent inheritance tax rate in this instance, they must be reported on decedent's
P'9nnsylvania inheritance tax return. 42 Pa. C.S.A. S8302; 72 P.S. SS9106, 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).
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, an attorney from the Department
of Revenue will not be attending the hearing regarding it. Please contact me if you or the Court
has any questions or requires anything additional from this Bureau. Finally, the approval of this
allocation is limited to this estate and does not reflect the position that the Department may
take in any other proposed distribution of proceeds of a wrongful death/survival action.
Sincerely,
Sl/ . lA C(:j~ tc (! Ie
Holly A. McClintock
Trust Valuation Specialist
PHONE: 717-787-1794 . FAX: 717-783-3467 . EMAll: hmcclintoc-wstate.pa.us
DEPARTMENT OF THE NAVY
OFFICE OF THE JUDGE ADVOCATE GENERAL
MEDICAL CARE RECOVEi'1Y UNIT NORFOLK
9053 FIRST STREET SUITE 100
NORFOLK. VA 23511-3605
January 7,2008
MR E RALPH GODFREY ESQ
SALZMANN HUGHES PC
354 ALEXANDER SPRING ROAD
CARLISLE PA 17015
Re: Injured:
Date of Incident:
Place of Incident:
Our File Number:
ML Ian Dagan (deceased), dependent child of CPO Paul Dagan,
USN (Ret )
January 11, 2007
Pennsylvania
NC0704042
Dear Mr. Godfrey,
Your request for a compromise of the Navy's claim under the Medical Care Recovery Act,
42 U.S.C. ~~ 2651 et seq., and the Third Party Payer's Act, 10 U.S.C. ~ 1095, in the matter of
ML Ian Dagan has been granted pursuant to 32 C.F.R. Part 757.19. Upon review of the
particular facts of this case, it has been determined that full collection of the Navy' s claim
would result in an undue hardship the Dagan family. The Navy, with the approval of the
Department of Justice, agrees to compromise its claim of $387,232.97, and will accept
$200,000.00 in full and complete satisfaction of the claim. Please forward a check, drafted in
the amount of $200,000.00, made payable to the United States Treasurer, to the letterhead
address as soon as practicable.
Should you have any questions, or otherwise wish to reach me, my telephone number is
(757) 440-6314. I may also be reached via e-mail atpamella.a.myersl@navy.mil.
Sincerely,
y~
Pamella A Myers
MEDCARE Attorney, MCRU Norfolk and
Managing Attorney, Medical Care Recovery Units