HomeMy WebLinkAbout04-24-0915056051058
REV-1500 EX (OS-05} OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 21 05 0871
_ Harrisburg, PA t7t28-O60t RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
517-72-9056 06/25/2005 09/23/1967
Decedent's Last Name Suffix Decedent's First Name MI
Morgan Tonya E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
O'Connell Devin J
Spouse's Social Security Number
THIS RETURN h1UST 8E FILED (N DU~LiCA T E WITH THE
335-66-0729 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
°~: 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death
4 Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
~: 9. Litigation Proceeds Received
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
between 12-31-91 and 1-1-95)
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
GORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
1-ricia D. Naylor (717) 243-7437
Flrm Name (If Applicable) REGISTER OF WILLS USE ONLY
Law Office of Tricia D. Naylor ~,
First line of address -/ rV_~ 4:_, -- --y ,--i1.
104 South Hanover Street
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Second line of address r~ r•.) - i :,
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DATE-f='tL-~D ~?
City or Post Office State ZIP Code
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Carlisle PA 17013 ,`~
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Cor dent's e-mail Y @ P
Under enalties erjury, d ~ that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is tru correct an I q.. claration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
~G~NA7 RE OF PERS R ONSIBLE FOR FILING RETURN PATE
- __ ~,.~ t _ _ - _
ADD S
10 al `te , T all, CT 06611
- - _ _ i - --- --- -
S~ RE OF P R O H TH PRESENTATIVE ~ j D ~E w
ADD S
104 outh Hanover rlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Tonya E Morgan 517-72-9056
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 8 Notes Receivable (Schedule D) ........................... .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 120,638.20
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. 120,638.20
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 14,478.37
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 3,000.00
11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 17,478.37
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 103,159.83
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. 103,159.83
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 66,579.92 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X .0 45 36,579.91 16. 1,646.09
'17. Amount of Line 14 taxable
at sibling rate X .12 17.
118. Amount of Line 14 taxable
at collateral rate X .15 1g.
19. TAX DUE ..
..................................................... 19
.. 1,646.09
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~;.
15056052059 Side 2
15056052059
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 05 0871
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Tonya E Morgan 517-72-9056
- -
- -
STREETADDRESS
809 Mandy Lane
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 1,646.09
2. CreditsiPayments
A. Spousal Poverty Credit _ _ _---__- _- -_--__ ._ . --..__- -
B. Prior Payments 2,800.00
C. Discount _.
Total Credits (A + B + C) (2) 2,800.00
3. InteresU'Penalty if applicable
D. 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.
Fill in oval on Page 2, Line 20 to request a refund, (4) 1,153.91
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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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. §9116 (a) (1.1) (i)J.
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 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 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)]. Asibling 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, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Tonga E. Morgan 21-05-0871
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.
(If more space is neeoeo, msen aaamonai sneers u. u~c sauic ~~L~~
REV-1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADM{N{STRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tonga E. Morgan 21-05-0871
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Ewing Brothers Funeral Home, Inc. 5,358.30
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
Clty State
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Virginia O'Connell
street Address 10232 Avalon Gates
city Trumball State CT
Relationship of Claimant to Decedent daughter
d. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
~. Additional Short Certificate
8. Legal Advertising -Cumberland Law Journal /Sentinel
Zip
Zip 06611
5,300.00
3,500.00
75.00
4.00
241.07
TOTAL (Also enter on line 9, Recapitulation) $ 14,478.37
(It more space is needed, insert additional sheets of the same size)
Ii E4' 7.51.' EXr iL'°%8)
Pennsylvania SCHEDULE I
- DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tonva E. Morgan 21-05-0871
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert agmnonai sneers or one same site.
rz~v-~sl3ex~ ii;-nr~,
mss'` Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
7ony'a E. Morgan 21-05-0871
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMESER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
1. Devin J. O'Connell 10232 Avalon Gates, Trumball, CT 06611 husband 66579.92
-pursuant to intestate succession Sec. 2102, spouse receives the first
$30,000 plus one-half of the balance of the intestate estate.
2. Virginia O'Connell 10232 Avalon Gates, Trumba{I, CT 06611 daughter 36579.91
-pursuant to intestate succession Sec. 2102, issue receives the share
of the estate to which the surviving spouse is not entitled.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WH[CH AN ELECTION TO TAX i5 NOT TAKEN
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -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.
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10/29/2008
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
Michael ,! Navisky
Navisky, Olson & Wisneski, LLP
2040 Linglestown Road
Suite 303
Harrisburg, PA 17110
Re: Estate of Tonya E. Morgan
Fife Number 2105-0871
Dear Mr. Navisky:
The Department of Revenue received the Petition filed on behalf of the above-referenced
Estate.
According to the Petition, the 37 year old decedent died as a result of small cell
neuroendocrine cancer. Decedent is survived by spouse and minor child.
ti ~ '
Pursuant to the Supreme Court of Pennsylvania, damages recoverable under a survival
action include those for future earnings. Kiser v. Schulte, 538 Pa. 219, 648 A.2d 1 (1994). This
is supported by the Commonwealth Court. Roberts v. Dungan, 574 A.2d 1193 (Cmwlth. Ct.
1990). A portion of the settlement proceeds of this action therefore must be allocated to the
survival action.
Please be advised that based upon these facts and for inheritance tax purposes only,
this Department would not object to the allocation of the net proceeds of this action,
$ 474,592.36 to the wrongful death claim and $ 118,648.09 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. §8302, 72 P.S. §9106, 9107.
I trust that this letter is a sufficient representation of the Department's position on this
matter. Please contact me if you or the Court has any questions or requires anything additional
from this Bureau.
Since e~y,
r{ ~~ ~1 '
Shannon E. Baker
Trust Valuation Specialist
Inheritance Tax Division
Bureau of Individual Taxes
~- os- Qg'7l
original PHONE: 717-783-5824 Fnx: 717-783-3467 ~t~: shabakerCstate.pa.us
DEVfN J. O'CONNELL, as
Administrator of the ESTATE OF
TONYA E. MORGAN, Deceased, and
DEVIN J. O'CONNELL, Individually and
in his own right,
Plaintiff
v.
PATHOLOGY ASSOCIATES OF
CENTRAL PENNSYLVANIA, P.C.,
MICHAEL S. BENTZ, M.D., PINNACLE
F[EALTH HOSPITALS t/d/b/a PINNACLE
HEALTH AT POLYCLINIC HOSPITAL,
PINNACLE HEALTH HOSPITALS
t/d/b/a PINNACLE HEALTH AT
HARRISBURG HOSPITAL,
Defendants
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IN THE COURT OF COMMON PLEAS
DAUPHIN COUNTY, PENNSYLVANIA
NO. 2006 CV 3394 MM
CIVIL ACTION -MEDICAL
PROFESSIONAL LIABILITY ACTION
JURY TRIAL DEMANDED
AND NOW, this ~~~ day of ~ ~ ~~/`~ , 20t.YU upon
consideration of the attached Petition for Approval of Decedent's Compromise Settlement and
Distribution of Proceeds,
IT IS HEREBY ORDERED THAT:
1) Settlement of the above-captioned action by Devin J. O'Connell, as Administrator
of the Estate of Tonya E. Morgan, Deceased, and Devin J. O'Connell, Individually and in his
ovm right, in accordance with the terms of the Petition, is hereby ratified and approved.
Reimbursement of Counsel's travel and parking expenses, however, is disapproved. The
amounts distributed pursuant to term of the Petition shall be modified accordingly. Devin J.
O'Connell is authorized to mark the above-captioned action settled, discontinued and ended as to
Defendants.
To N y ~ ~. ~ o ~a~rrJ ch>7u.n~ ~'cl,Qdn~.~ ~
fit- bs-ag7 ~
2) All proceeds will be allocated as set forth in paragraphs .15 through 20 of -~~
Plaintiff's Petition for Approval of Decedent Compromise Settlement and Distribution of
Proceeds. That cash portion of the settlement proceeds to be paid to Devin O'Connell for the
benefit of the minor Plaintiff pursuant to paragraphs 19 and 20' of the Petition shall be deposited
in a federally insured account in the minor's name in a bank that does business in Pennsylvania.
The account shall be marked "Restricted. No withdrawal prior to age 18 without prior Court
Approval." An affidavit of Deposit as to all of the minor's funds shall be provided to the Court
within twenty (20) days of the date of this Order.
BY THE COURT:
cc: Nijole Olson, Esquire, 2040 Linglestown Road, Suite 303, Harrisburg, PA 171 l0
(717) 541-9205, nolson@nowllp.com, (717) 541-9206 (fax)
Michael M. Badowski, Esquire, 3510 Trindle Road, Camp Hi11, PA 17011
(717) 975-8114, mbadowski@margolisedelstein.com, (717) 975-8124 (fax)
Thomas M. Chairs, Esquire, 1200 Camp Hill Bypass, Suite 205, Camp Hill, PA 1701 1
(717) 731-4800, tchairs@dmclaw.com, (717) 731-4803 (fax)
J.
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vernon Commons
520 Hartford Ilirripike
Vr;mott, Connecticut 06066
(864) $75~3$ly
April 22, 2401)
F,state of "Tonya organ
c/o Deviw O'Co ell
ESTATE AP~RAIS~-L
Diamond engagt
diamond ig F co:
7.49x4,59x2.~
A thick fsrceted g
2.8mm aizd 1~ave
white gold head,
yellow gold ~
al the bottom of
meet ring and matching wedding band, saldtrcxl tugethcr. Fear-shaped canter
~r, 512 clarity, and vvei~;hs approximately t1.51 carat, measuros $pproxisnately
pmm, hfas a Depth Proportion of 52,3°l, and a Table Proportion of 61%, and has
relic. Niue 6211 cut melee diamonda mte Sll clarity, .`-G color, mnaaure 2,7 -
atotal approximate weighx of U,70 carat. Center ciirunund is set iii. a Six-pmn,~,
and melee diamonds are set in four prong, white gold heads i.n mauntitt&s with
ks stamped 14ic, soldercxi to~ather and tapering from 6.Smn, at the top to 3.3n1m
he shank, fnger sir_c; 6'~~. Total sing weight is 3.3 dwt.
$1,t350.(i0
~-- ~j~
Ja uel I3. trio rich
Ciracluate Ciemulagiyt, G1A
L;nd of Appraisal
l~ote: Unless v herwiso stated, ail weights, measurements and grades ttre approximate, and
l;crostoncs storxe have not been remt~ved from IhCir mountings for grading. i.)iamonds and
c:olnred gamst shave been graded in acec~rdanac with systexx~s t=.stablisheei by the CTemological
lnytitute of Am icA (UTAj. 13ecav.5c jewelry apprr~isdl and evaluation arc subjective sciences,
a w ~ ~1- ~ . r Yt~ K' 6A--~ Q-ft-~c h m~fi ~,~e h~-d,+A ~~- ~ ~.~ ~ ass. n ~ '71
I
Ji"LedNiGf2 ecve~er3, ~r~c .
estimates of vall~e play vazy from one appraiser to another, and such variances 8n not tlecessafily
constitute an errWlr on the part of the appraiser.
Identification of . etal duality as stamped on the indiYidual articles cannot be considered
conclusive. In a absenkc of a quality stamp, we have been limited to a metal test and the
quality of Lhe m al approximateti that arc set oi,t in the appraisal,
This appraisal r ore has been undertaken to determine tk-e fair market value of the ilenis listed
and is to be used only for the purpose of estate tax, It is invalid if need for any oti•.ier purpose.
Continuation of Schedule H
Estate of File Number
Tonya E. Morgan 21-OS-0871
ITEM B. 3. Family Exemption -Explanation of Difference in Address:
Virginia O'Connell lived with her mother (Tonya E. Morgan) at 809 Mandy Lane, Camp
Hill, PA until her mother's death. Virginia O'Connell now lives with her father at 10232
Avalon Gates, Trumball, CT.