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Home My WebLink About06-24-08 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X.280601 2 1 0 6 0 6 2 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198 80 8610 06 13 2006 11 01 2002 Decedent's Last Name Suffix Decedent's First Name MI TAYLOR DREW 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 X 1. Original Return 2. Supplemental Return L ,I 3. Remainder Return (date of death - prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ _I 5. Federal Estate Tax Return Required - (date of death after 12-12-82) - g Decedent Died Testate r- 1 7 Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) - (Attach Copy of Trust) X 9. Litigation Proceeds Received ' 10. spousal Poverty Credit (date of death 1 11. Election to tax under Sec. 9113(A) _. __-. between 12-3t-91 and 1-1-95) ~~- J (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A. WEIGLE ESQUIRE 717 532 7388 Firm Name (If Applicable) WEIGLE & ASSOCIATES, P.C. First line of address 126 EAST KING STREET Second line of address City or Post Office SHIPPENSBURG Correspondent's a-mail address: State ZIP Code PA 17257 REGI TER OF WILb$ USE ONLY $ ~ ,~ r_' ~ _ M1~ '- ~ a -- _:. r l ~\ ~ C ' f -? C .~ ° ,, ~_ ,; Z7 DATE F - D - -> Z .. r - - v1 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 ail information of which preparer has any knowledge. SIGNAT RE OF P!~E__RQQSOtN RESPONSIBLE FOR FILING RETURN DATE uv~'t-c ~ ~~~..~ Randall L. Taylor ~-~ ~ -- ~ ~ Aft RFSS 17257 $fGNATUf~F PRE>~R (yF>•i€R THAN EP S TI E DATE / I fff/// ~'r ~ Jerry A. Weigle Esquire 126 East King Street, Shi 15l]56041147 A 17257 Side 1 15056041147 ~ ~~~ ''-~ ~~J V~~ ~~~ ~ v ~~ ~, a ~ ~~ ~ ~~~ .~ ~ ~ ~,~ ~ ~ ~~ f ~r PA Inheritance Tax Return Signature of Additional Fiduciaries I ESTATE OF I FILE NUMBER I l Taylor, Drew Michael 21-06-0623 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 auz rcicnwaiter street PA 17257 D~ 15056042148 REV-1500 EX Decedent's Social Security Number Decedenes Name. ~ P e W M I C it a e i T a ~/ I O r 1 9 8 8 0 8 6 1 0 RECAPITULATION 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. 3 3 7 5 0 0 0 0 0 6. Jointly Owned Property (Schedule F) i= 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) ..................................................................... .. g. 3 3 7 5 0 0 0 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9. 8 8 7 8 3 0 3 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 1 0 1 1 6 8 5 0 11. Total Deductions (total Lines 9& 10) ................................................................... ... 11 9 8 8 9 9 8 8 9 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 2 3 8 6 0 0 1 1 1 13. Charitable and Governmental Bequests/Sec 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. 2 3 8 6 0 0 1 1 1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 2 3 8 6 0 0 1 1 1 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17~ 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18• 0 0 0 19. Tax Due ...................................................................................... ................ .............. . 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 J REV-1500 EX Page 3 File Number 21-06-0623 Decedent's Complete Address: Drew Michael Taylor I STREET ADDRESS 402 Richwalter Street, Borough of Shippensburg CITY ~ STATE ~ ZIP Shippensburg PA j 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) _ O.OQ 2. CreditslPayments A. Spousal Poverty Credit g. Prior Payments -- _ ----- C. Discount 0.00 -__ _ _ _ __ Total Credits (A + B + C) (2) 0.0 3. InteresUPenalty if applicable p. Interest E. Penalty --_ ___ - - Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 0.00 q. Enter the interest on the tax due. (5A) __. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Q , Q Q Make Check Payable to: REGISTER OF W/LLS, 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 :.................................................................................. ' x ~ . '`' , ' x c. retain ahrevehsionaeSinte eswoo shaA use the property transferred or its income;",;;;,,." .::::::..:..:.:..~ . .• ~ Ir_x, ry ................................................................................................... ~_ J d. receive the promise for hfe of ether payments, benefits or care........... J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................................I I i x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... i x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... '~ ! x 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)]. 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 Ju{y 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 decedent's 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. Rev-'1508 EX* (8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Taylor, Drew Michael _21-06-0623 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntlyowned with the right of survivorship must be disclosed on schedule F. (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-115'1 EX+ 112.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Taylor, Drew Michael 21-06-0623 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 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 Weigle & Associates, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Randall L. and Marcie E. Taylor Street Address 402 Richwalter Street, Borough of City Shippensburg State PA zip 17257 Relationship of Claimant to Decedent Parents 9,183.75 3,500.00 4. Probate Fees Register of Wills, Cumberland County 43.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 875,103.64 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 887,830.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ ~6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-A FUNERAL EXPENSES continued ESTATE OF (FILE NUMBER Taylor, Drew Michael _ _ 21-06-0623 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1902 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Taylor, Drew Michael 21-06-0623 ITEM NUMBER DESCRIPTION AMOUNT 1 Kirby 8~ Holt, LLP -prepaid expenses for survival action 30,035.64 2 Kirby 8 Holt, LLP -attorney fee for survival action 843,750.00 3 Medical Center Radiologists 1,273.00 4 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 5 Register of Wills, Cumberland County -certified copies of Grant of Letters for North 30.00 Carolina attorney Subtotal ~ 875,103.64 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98) , Rev-1512 EX+t6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF (FILE NUMBER Taylor, Drew Michael 21-06-0623 Include un~elmbursed medical expenses. (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 I (Rev. 6-98) . REV-1573 EX+ i9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIAR{ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Taylor, Drew Michael 21-06-06 23 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words ) ($~$) Do Not Llst Trustees I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Marcie E. Taylor Mother One-half 1,193,000.56 402 Richwalter Street Shippensburg, PA 17257 2 Randall L. Taylor Father One-half 1,193,000.55 402 Richwalter Street Shippensburg, PA 17257 Total 2,386,001.11 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r 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 ii -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) sr~arzoo7 KIRBY & HOLT, L.L.P. Settlement Statement for Estate of Drew Michael Taylor File #12410 Settlement Proceeds T~tat Settlement Proceeds: 3,375,000:00 Attorneys Fees (1/3 x $3,375,000.00 = $'!,725,000.00, adjusted to 2596 x$3,375,00(1.00 = $843, 750.00 as per DFK) Kirby & Ho#t, LLP 843,750.00 Prepaid Expenses Kirby & Hoit, LLP 30,035.64 LiensJrUther Expenses Fogelsanger-6ridcer Funeral Home, Inc. 9,183.75 Corolla Fire and Rescue 654.50 Medical Center Radiologists 1,273.00 Pathology Sciences Medical Group 514.00 *CSA Travel Protection 100,000.00 Totat Fees and t_xper~ses: Net Settlemernt Proceeds due to Beneficiaries of Estate: ~~ ~ ~~ Randy L Taybr, Personal Representative of the Estate of Drew M. Taylor Marcie Taylor, Personal Represen of the// Est .#~of Drew M. Taybr ~ ~ ~ 3,375,000.00 983,410.84 ?,389,589.11 `Escrowed for determination of legal validity of lien daimed by CSA Travel.