Loading...
HomeMy WebLinkAbout09-02-10 15056041046 REV-1500 EX (05-04) ' ~Y IOFF,C,Ai t)SE Ot PA Department of RAvenue Bureau of Individual Taxes County Code Year File Number Dept.28060t INHERITANCE TAX RETURN S C E ~~ ~ ~ ~~ ~`j ~ of `~ _ _ Harrisburg, PA 17128-0601 RE IDENT DE ED NT [ ( [ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ..... ... 1 36 ,2~ 7~9~ o7a 9~od 8 07 13 ~ Y3 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI K~-GL£~ SA~~ C Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ® 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE 61<;ECTED TO: Name Daytime Telepk~e Number o ""~' S A R ~- c K~ ~~ ~. R .,,. 7 ~ 7 ~;©~ ~° ~~~ ; Firm Name (If Applicable) First line of address y 5.3 S rA.r~ ~7~ ~~.r Second line of address City or Post Office ~~o L~4 DATE FILED State ZIP Code L ~A~ I '7o~S ~ ~~ ., i :,_; -.,. + <~~ --; Correspondent's a-mail address: ,SC J(((~ ~,gr C M 5 t~ . C;O M 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. SIG~OF ARSON R SPO SIBLE FOR FILING RETURN DATE .t/L/1 (3~I0~ ~,~ n /D ADDRESS X53 .~2 .~~' . C~u~a. ~°f~ l 7oa..s SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 5056041046 J 15056042047 REV-1500 EX Decedent's Social Security Number -{'. FJ ~~ 1~~ .. ~~~~._ ._ _ .. ... .. ' . _ ,:. _ ~_ ~- ~ ~ ._~ ,~.C~ Decedent s Name: REC APITULATION 1. Real estate (Schedule A) . ............................................ 1. 0 , D O O O ~ 2. Stocks and Bonds Schedule B 2 3. Closely Held Corporation, Partnership or Bole-Proprietorship (Schedule C) ..... 3. 0 U 0 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. ~ •b CJ 5. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E P P Y( ) ....... . 5. ~ . O ~ 6. Jointly Owned Property (Schedule F) C Separate Billing Requested ...... . 6. O D O • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 O O (Schedule G) C Separate Billing Requested....... . 7. , 8. Total Gross Assets (total Lines 1-7) ................................... . 8. 0 . 4 O 9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 9. 0 . C ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. ~ ~ D O 11. Total Deductions (total Lines 9 & 10) .................................. . 11. ~ ~ d 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. O ~ O ~' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which O O an election to tax has not been made (Schedule J) ....................... . 13. O . 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. C . O ~ 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 . 15. 16. Amount of Line 14 taxable at lineal rate X .0 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. • 19. TAX DUE ........................................................ .19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042047 15056042047 O REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ J(~8-~ C7~~T DECEDENT'S NAME j STREET ADDRESS _~5.3 ~~~~~ str~E~ CITY l NO [Gt- -_ __ STATE -__ - ZIP / 70 ~.~' Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit __ _- - - B. Prior Payments - ___ C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty 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) 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 transferretl :................................................................................... ....... ^ X^ 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 "intrust 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)]. 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+It-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTD EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER J` i,~~51 ~ y .l~ugl~~ ~ ~~~ _ ~ ysy Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH .~Z~u~L ~ TOTAL (Also enter on line 5, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) JEFRiEY B. SwON (C0. NY, TX) JESSIGI M. DEIW (CA, TX) RoN C. EoowS (CA, TX) TYSON B. GCE (CA) Dnw C. CroNE (CA, NY, TX) Roeerr A GREEN (cA) ETwwA HORN (CA) JENN~Bt L. t3ARTl.ETi (CA) CNRlSTOPtER J. PMNTB2 (CA, TX) H.W. TREY JONES (C11, TX) l1 P. A~CDOWELL (TXj ~ (~) I(~n~trN A PRroR (nc) BRUw P. Bu~ow (CJQ Srtwsr J. PuRUr (CA) ,LpROµg~~~ SIMON, EDDIN9 6c GREEIVSTONE, LLP (~ ~~ ~(~ BENr~rxr D. t3RALY (CA, TX) ~~ UtNtA M. Cneurr0 (fX) DANA C. S~roN (TX) Cu-r B. CaRRO~L (CA, TX) J. BRAOI.Er SMRN (iX) SEAN R. Cox (TX) Cww~ES E. SaECNnNC, JR. (Tx) REeECxa- A Ctx:u (a) JAY E. SiuE~ (TX) PLEASE RESPOND TO THE TEXAS OFFlCE June 28, 2010 Sara Kugler 453 State Street Enola, PA 17025 RE: Union Carbide Corporation Settlement Dear Ms. Kugler, Enclosed is a check for the Union Carbide Corporation settlement. The information below details the calculation of your payment. Settlement Amount $ 400,000.00 Attorney fees 40% $ 160,000.00 Case Expenses $ 39,814.97 Amount Due to Client $ 200,185.03 Please do not hesitate to contact me with any questions or concerns. Thank you, ~~~,rn~m ~ ~~ Vicky Daneman Settlement Processor TEXAS OFFICE: ~ ~~: 3232 MCKLNNEY AvENUE, SuiTE 610 301 E. OCEAN BLw., SuLTE 1950 DALLAS, TEXAS 75204 ATTORNEYS & COUNSELORS AT LAW LONG ~~' ~"~' 90802 TEL: 214.276.7680 ~ TEL: 562.590.3400 FAX: 214.276.7699 www.Seglaw.COm FAX: 562.590.3412 JEFFREY B. SIMON (CA, NY, TX) Row C. EDDINS (CA, TX) DAVro C. GREENSTONE (CA, NY, TX) JENNIFER L. BARTLETT (CA) CHRISTOPFIER J. PANAT~R (CA, TX) UT LISA M. BARLEY (CA) BRUw P. BARROW (CA) JoROAN BLUMENFELD,IAMES (CA) BENJAMW D. BRALY (CA, TX) LAURA M. CABUTTO (TX) CLAY B. CARROU. (CA, TX) SEAN R. COX (nc) SIMON, EDDINS & GREENSTONE, LLP PLEASE RESPOND TO THE TEXAS OFFICE July 28, 2010 Sara Kugler 453 State Street Enola, PA 17025 RE: CertainTeed Corporation Settlement Dear Ms. Kugler, REBECCA A. CLICU (cA) JESSicn M. DEAN (CA, TX) TYSON B. GAMBLE (CA) ROBERT A. GREEN (CA) ETHAN A. HORN (CA) DARKEN P. MCDOWEU (TX) RACHEL C. PERKWS (TX) KATHRYN A. PRYOR (TX) STUART J. PURDY (CA) ALEXANDRA SHEF (CA) LISA WHRE SHIRLEY (FL, tA, TX) DANA C. SIMON (TX) J. BRADLEY SMITH (TX) JAY E. STUEMKE (TX) Enclosed is a check for the CertainTeed Corporation settlement. The information below details the calculation of your payment. Settlement Amount $ 550,000.00 Attorney fees 40% $ 220,000.00 Case Expenses $ 68,069.20 Amount Due to Client $ 261,930.80 Please do not hesitate to contact me with any questions or concerns. Thank you, ~~ W ~ Vicky Daneman Settlement Processor --- _ -- - TEXAS OFFICE: CALIFORNIA OFFICE: 3232 MCKINNEY AVENUE, SUITE 610 301 E. OCEAN BLVD., SUITE 1950 DALLAS, TEXAS 75204 ATTORNEYS & COUNSELORS AT LAW LONG BEACH, CALIF. 90802 TEL: 214.276.7680 TEL: 562.590.3400 r..,. con cnn nun REV-1509 EX ~ (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A.Sara- ~. ~+,~~~~ r ADDRESS hf53 S~t~ 5f. E"~vo14- , i~r~ RELATIONSHIP TO DECEDENT t,cl ~ ~ ~ B C Inwrl Y-owNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) I S (If more space is needed, insert additional sheets of the same size)